Provider Demographics
NPI:1013211499
Name:HEART SAIL
Entity Type:Organization
Organization Name:HEART SAIL
Other - Org Name:HEART SAIL MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LETSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-309-5454
Mailing Address - Street 1:PO BOX 1672
Mailing Address - Street 2:
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640-8672
Mailing Address - Country:US
Mailing Address - Phone:256-309-5454
Mailing Address - Fax:256-309-5455
Practice Address - Street 1:107 SYCAMORE ST NW
Practice Address - Street 2:
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640-2427
Practice Address - Country:US
Practice Address - Phone:256-309-5454
Practice Address - Fax:256-309-5455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL143076Medicaid