# TENNESSEE VALLEY VASCULAR CONSULTANTS PC

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

## Provider details

- **NPI number:** 1780613059
- **Authorized official:** FRED S STUCKY III MD (PRESIDENT)
- **Authorized official phone:** (256) 265-7480

## Contact information

- **Practice address:** 420 LOWELL DR SE, SUITE 500, HUNTSVILLE, AL 35801-3754
- **Practice address phone:** (256) 265-7480
- **Practice address fax:** (256) 265-7481
- **Mailing address:** 420 LOWELL DR SE, SUITE 500, HUNTSVILLE, AL 35801-3754
- **Mailing address phone:** (256) 265-7480
- **Mailing address fax:** (256) 265-7481

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | 00016783 | AL | — |
| 2086S0129X | Vascular Surgery Physician | 00017567 | AL | — |
| 2086S0129X | Vascular Surgery Physician | 0008023 | AL | Yes |

## Other

- **Enumeration date:** 06/30/2006
- **Last updated:** 06/06/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0004070317 | AETNA | — |
| 01 | — | 0005683727 | AETNA | — |
| 01 | — | 0005999121 | AETNA | — |
| 05 | — | 051514734 | — | AL |
| 05 | — | 051514735 | — | AL |
| 05 | — | 051514736 | — | AL |
| 01 | — | 51514734JOH | BLUE CROSS BLUE SHIELD | AL |
| 01 | — | 51514735STU | BLUE CROSS BLUE SHIELD | AL |
| 01 | — | 51514736LOW | BLUE CROSS BLUE SHIELD | AL |
| 01 | — | P00000016 | MEDICARE RAILROAD | AL |
| 01 | — | P00000017 | MEDICARE RAILROAD | AL |
| 01 | — | P00000018 | MEDICARE RAILROAD | AL |