Healthcare Provider Details

I. General information

NPI: 1508360181
Provider Name (Legal Business Name): NEPHROLOGY VASCULAR LAB OF CENTRAL ALABAMA ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 COLUMBIANA RD STE 120
VESTAVIA HILLS AL
35216-1642
US

IV. Provider business mailing address

PO BOX 412142
BOSTON MA
02241-2142
US

V. Phone/Fax

Practice location:
  • Phone: 205-916-5201
  • Fax: 205-916-5274
Mailing address:
  • Phone: 610-644-8900
  • Fax: 484-924-0053

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: DR. GREGG ARTHUR MILLER
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 717-515-4048