# VEIN & COSMETIC CENTER OF PRATTVILLE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407298920
- **Authorized official:** DR. JOHN R KINGSLEY (PRESIDENT & OWNER)
- **Authorized official phone:** (205) 823-0151

## Contact information

- **Practice address:** 509 PINNACLE PL, PRATTVILLE, AL 36066-6544
- **Practice address phone:** (205) 823-0151
- **Practice address fax:** (205) 823-5218
- **Mailing address:** 700 MONTGOMERY HWY, SUITE 210, VESTAVIA, AL 35216-1866
- **Mailing address phone:** (205) 823-0150
- **Mailing address fax:** (205) 823-5218

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 280663 | AL | Yes |

## Other

- **Enumeration date:** 07/25/2013
- **Last updated:** 07/25/2013