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General NPI Number Information
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NPI Number | 1780613059
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Entity Type | Organization
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Legal Business Name | TENNESSEE VALLEY VASCULAR CONSULTANTS PC
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 06/06/2008
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Provider Practice Location Address
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Address Line | 420 LOWELL DR SE SUITE 500
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City | HUNTSVILLE
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State | AL
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Zip | 35801-3754
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Country | US
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Telephone | 256-265-7480
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Fax | 256-265-7481
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Provider Business Mailing Address
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Address Line | 420 LOWELL DR SE SUITE 500
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City | HUNTSVILLE
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State | AL
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Zip | 35801-3754
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Country | US
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Telephone | 256-265-7480
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Fax | 256-265-7481
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Authorized Official
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Title or Position | PRESIDENT
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Name | FRED S STUCKY III
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Credential | MD
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Telephone | 256-265-7480
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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 | 00016783
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 00017567
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 0008023
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License Number State | AL
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