Healthcare Provider Details

I. General information

NPI: 1801282868
Provider Name (Legal Business Name): VASCULAR ASSOCIATES OF SOUTH ALABAMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 OLD SHELL RD
MOBILE AL
36604-1354
US

IV. Provider business mailing address

PO BOX 850849
MOBILE AL
36685-0849
US

V. Phone/Fax

Practice location:
  • Phone: 251-410-8272
  • Fax: 251-410-8273
Mailing address:
  • Phone: 251-343-5004
  • Fax: 251-343-0833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANDREW RADOSZEWSKI
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 251-300-6969