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General NPI Number Information
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NPI Number | 1972671444
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Entity Type | Organization
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Legal Business Name | HUNTSVILLE VASCULAR SPECIALISTS, PC
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 06/03/2009
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Provider Practice Location Address
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Address Line | 900 BOB WALLACE AVE SW SUITE 114
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City | HUNTSVILLE
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State | AL
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Zip | 35801-5691
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Country | US
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Telephone | 256-883-8222
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Fax | 256-883-8230
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Provider Business Mailing Address
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Address Line | PO BOX 18844
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City | HUNTSVILLE
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State | AL
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Zip | 35804-8844
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Country | US
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Telephone | 256-883-8222
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Fax | 256-883-8230
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Authorized Official
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Title or Position | OWNER
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Name | DR. GARY M. GROSS
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Credential | M.D.
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Telephone | 256-883-8222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 8969
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License Number State | AL
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