Provider Demographics
NPI:1063510618
Name:INTERVENTIONAL CARDIOLOGY, PLLC
Entity Type:Organization
Organization Name:INTERVENTIONAL CARDIOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:STUBBLEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-495-0521
Mailing Address - Street 1:605 GLENWOOD DRIVE
Mailing Address - Street 2:SUITE 412
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1175
Mailing Address - Country:US
Mailing Address - Phone:423-495-0521
Mailing Address - Fax:423-648-0708
Practice Address - Street 1:605 GLENWOOD DRIVE
Practice Address - Street 2:SUITE 412
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1175
Practice Address - Country:US
Practice Address - Phone:423-495-0521
Practice Address - Fax:423-648-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN012834207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3729081Medicare ID - Type Unspecified