Healthcare Provider Details

I. General information

NPI: 1295013696
Provider Name (Legal Business Name): VASCULAR CENTER OF MOBILE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 DAUPHIN ST
MOBILE AL
36604
US

IV. Provider business mailing address

1151 DAUPHIN ST
MOBILE AL
36604-2547
US

V. Phone/Fax

Practice location:
  • Phone: 251-445-0075
  • Fax: 251-445-0072
Mailing address:
  • Phone: 251-455-0075
  • Fax: 251-445-0072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD19175
License Number StateAL

VIII. Authorized Official

Name: ALYSSA N SEABROOK
Title or Position: INSURANCE SPECIALIST
Credential:
Phone: 251-445-0075