Healthcare Provider Details

I. General information

NPI: 1932830304
Provider Name (Legal Business Name): MEDVARO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 11TH AVE S STE B
BIRMINGHAM AL
35205-4704
US

IV. Provider business mailing address

PO BOX 11131
BIRMINGHAM AL
35202-1131
US

V. Phone/Fax

Practice location:
  • Phone: 205-837-3339
  • Fax:
Mailing address:
  • Phone: 205-837-3339
  • Fax: 205-707-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT GARCIA
Title or Position: COO
Credential:
Phone: 205-837-3339