1104193069 NPI number — EAST ALABAMA HEART AND VASCULAR, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104193069 NPI number — EAST ALABAMA HEART AND VASCULAR, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST ALABAMA HEART AND VASCULAR, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PINNACLE CARDIOVASCULAR ASSOCIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104193069
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2601 VILLAGE PROFESSIONAL DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OPELIKA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36801-4784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-528-5400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2601 VILLAGE PROFESSIONAL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OPELIKA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36801-4784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-528-5400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PRICE
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
334-528-1310

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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