Healthcare Provider Details

I. General information

NPI: 1629647268
Provider Name (Legal Business Name): UNITED VASCULAR OF HUNTSVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 WHITESBURG DR SW STE 300
HUNTSVILLE AL
35802-1685
US

IV. Provider business mailing address

4700 WHITESBURG DR SW STE 300
HUNTSVILLE AL
35802-1685
US

V. Phone/Fax

Practice location:
  • Phone: 256-692-5100
  • Fax: 256-288-3980
Mailing address:
  • Phone: 256-692-5100
  • Fax: 256-288-3980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTY MUSIC
Title or Position: AO-DIRECTOR OF PHYSICIAN CREDENTIAL
Credential:
Phone: 615-465-7377