Provider Demographics
NPI:1427499789
Name:CARDIAC INSTITUTE OF SOUTH ALABAMA, LLC
Entity type:Organization
Organization Name:CARDIAC INSTITUTE OF SOUTH ALABAMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MASHAWN
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-526-2200
Mailing Address - Street 1:101 PARK PL
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-6764
Mailing Address - Country:US
Mailing Address - Phone:334-526-2200
Mailing Address - Fax:334-526-2220
Practice Address - Street 1:101 PARK PL
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6764
Practice Address - Country:US
Practice Address - Phone:334-526-2200
Practice Address - Fax:334-526-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain