Provider Demographics
NPI:1114355120
Name:HUNTSVILLE CARDIOVASCULAR CLINIC, P.C.
Entity Type:Organization
Organization Name:HUNTSVILLE CARDIOVASCULAR CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-880-1050
Mailing Address - Street 1:4601 WHITESBURG DR SE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1676
Mailing Address - Country:US
Mailing Address - Phone:256-880-1050
Mailing Address - Fax:
Practice Address - Street 1:4601 WHITESBURG DR SE
Practice Address - Street 2:SUITE 201
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1676
Practice Address - Country:US
Practice Address - Phone:256-880-1050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-30
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-109897363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-109897OtherCRNP COLLABORATIVE PRACTICE LICENSE