General and Vascular Surgery of Northwest Alabma, Inc.

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

23436 Issued in AL

Legal business name

GENERAL AND VASCULAR SURGERY OF NORTHWEST ALABMA, INC.

Practice address

15225 Highway 43 Ste D
Russellville, AL 35653-1969

Phone

(256) 332-1500

Fax

(256) 398-8888

NPI assigned

Sep 22, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jeffrey Manord Sr.NPI 1275587552

Title

President

Phone

(256) 332-1500

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeffrey Derrick Manord, M.D.

  • Vascular Surgery Physician
  • Russellville, AL
  • NPI 1275587552
  Medicare reassignment NPD Authorized official
• Jeff L Ryan, MD

  • Surgery Physician
  • Ketchikan, AK
  • NPI 1548200504
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648512000000",
    "number": "1154639227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 660",
            "city": "RUSSELLVILLE",
            "state": "AL",
            "postal_code": "356530616",
            "telephone_number": "256-332-1500",
            "fax_number": "256-398-8888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15225 HIGHWAY 43 STE D",
            "city": "RUSSELLVILLE",
            "state": "AL",
            "postal_code": "356531969",
            "telephone_number": "256-332-1500",
            "fax_number": "256-398-8888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "203 Avalon Ave Ste 120",
            "address_purpose": "LOCATION",
            "city": "Muscle Shoals",
            "state": "AL",
            "postal_code": "356612857",
            "country_code": "US",
            "telephone_number": "256-332-1500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GENERAL AND VASCULAR SURGERY OF NORTHWEST ALABMA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-22",
        "last_updated": "2022-03-29",
        "certification_date": "2022-03-29",
        "status": "A",
        "authorized_official_last_name": "MANORD",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "256-332-1500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "AL",
            "license": "23436",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126776",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "511-17526",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Franklin Pharmacy LLC (Franklin Pharmacy)
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• Makayla Grace Franks
• Freds Stores of Tennessee Inc (Freds Pharmacy 2791)
• Randall Freemon
• Randy Wade Gooch, PHARMD
• John Terry Graves, D.M.D
• Sidney Greenberg, O.D.
• Stuart M Greenberg, O.D.
• Ryan Albert Gregorio, MD

• Vascular Surgery Physician in Russellville, AL
• Providers in Russellville, AL by specialty
• Vascular Surgery Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.