Provider Demographics
NPI:1073120119
Name:EAST ALABAMA HEART AND VASCULAR, LLC
Entity Type:Organization
Organization Name:EAST ALABAMA HEART AND VASCULAR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:334-528-1310
Mailing Address - Street 1:2601 VILLAGE PROFESSIONAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-4784
Mailing Address - Country:US
Mailing Address - Phone:334-528-5400
Mailing Address - Fax:
Practice Address - Street 1:2601 VILLAGE PROFESSIONAL DRIVE
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-4784
Practice Address - Country:US
Practice Address - Phone:334-528-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE EAST ALABAMA HEALTHCARE AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty