Provider Demographics
NPI:1114080926
Name:SOUTHEASTERN CARDIOLOGY CONSULTANTS
Entity Type:Organization
Organization Name:SOUTHEASTERN CARDIOLOGY CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCCAA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-590-7945
Mailing Address - Street 1:2055 E SOUTH BLVD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116
Mailing Address - Country:US
Mailing Address - Phone:334-613-0807
Mailing Address - Fax:334-386-4175
Practice Address - Street 1:2055 E SOUTH BLVD
Practice Address - Street 2:SUITE 403
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116
Practice Address - Country:US
Practice Address - Phone:334-613-0807
Practice Address - Fax:334-386-4175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7842174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL=========OtherEIN
ALC71821Medicare UPIN
ALQ57051Medicare UPIN
ALS84191Medicare UPIN
ALC71824Medicare UPIN
AL051556881Medicare PIN
AL=========OtherEIN
ALG81858Medicare UPIN