Provider Demographics
NPI:1215265939
Name:VASCULAR SPECIALISTS OF MOBILE, P.C.
Entity type:Organization
Organization Name:VASCULAR SPECIALISTS OF MOBILE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:ESSES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-432-0558
Mailing Address - Street 1:171 MOBILE INFIRMARY BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3509
Mailing Address - Country:US
Mailing Address - Phone:251-432-0558
Mailing Address - Fax:251-432-0554
Practice Address - Street 1:90 INDUSTRIAL PARK CIR
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5800
Practice Address - Country:US
Practice Address - Phone:228-327-5225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20777174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000030017Medicaid
AL000030017Medicaid
AL000030017Medicare PIN