Provider Demographics
NPI:1003834672
Name:SOUTHEASTERN CARDIOVASCULAR ASSOCIATES PC
Entity Type:Organization
Organization Name:SOUTHEASTERN CARDIOVASCULAR ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:PLANZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:M D
Authorized Official - Phone:334-794-2825
Mailing Address - Street 1:2431 W MAIN ST
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1217
Mailing Address - Country:US
Mailing Address - Phone:334-794-2825
Mailing Address - Fax:334-793-5050
Practice Address - Street 1:2431 W MAIN ST
Practice Address - Street 2:SUITE 1001
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1217
Practice Address - Country:US
Practice Address - Phone:334-794-2825
Practice Address - Fax:334-793-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000072082086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALE404Medicare ID - Type Unspecified