Healthcare Provider Details

I. General information

NPI: 1306978507
Provider Name (Legal Business Name): BIRMINGHAM VASCULAR ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 BROOKWOOD MEDICAL CTR DR SUITE 214
BIRMINGHAM AL
35209-6898
US

IV. Provider business mailing address

2018 BROOKWOOD MEDICAL CTR DR SUITE 214
BIRMINGHAM AL
35209-6898
US

V. Phone/Fax

Practice location:
  • Phone: 205-423-2495
  • Fax: 205-423-2498
Mailing address:
  • Phone: 205-423-2495
  • Fax: 205-423-2498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number23846
License Number StateAL

VIII. Authorized Official

Name: ROBERT WILLIAM HEIDEPRIEM, III
Title or Position: OWNER
Credential: MD
Phone: 205-423-2495