Healthcare Provider Details

I. General information

NPI: 1003323619
Provider Name (Legal Business Name): PRECISION VEIN THERAPEUTICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2018
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4112 WATERMELON RD
NORTHPORT AL
35473
US

IV. Provider business mailing address

3504 COLD HARBOR LN
MOUNTAIN BRK AL
35223-1636
US

V. Phone/Fax

Practice location:
  • Phone: 205-710-3800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ROSS BARLOW
Title or Position: OWNER
Credential: MD
Phone: 205-243-6264