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General NPI Number Information
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NPI Number | 1306978507
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Entity Type | Organization
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Legal Business Name | BIRMINGHAM VASCULAR ASSOCIATES, PC
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 01/15/2014
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Provider Practice Location Address
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Address Line | 2018 BROOKWOOD MEDICAL CTR DR SUITE 214
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City | BIRMINGHAM
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State | AL
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Zip | 35209-6898
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Country | US
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Telephone | 205-423-2495
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Fax | 205-423-2498
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Provider Business Mailing Address
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Address Line | 2018 BROOKWOOD MEDICAL CTR DR SUITE 214
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City | BIRMINGHAM
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State | AL
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Zip | 35209-6898
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Country | US
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Telephone | 205-423-2495
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Fax | 205-423-2498
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT WILLIAM HEIDEPRIEM, III
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Credential | MD
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Telephone | 205-423-2495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 23846
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License Number State | AL
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