Provider Demographics
NPI:1235482340
Name:GRENADA CARDIOLOGY LLC
Entity Type:Organization
Organization Name:GRENADA CARDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SEIBEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:662-227-9991
Mailing Address - Street 1:PO BOX 2153
Mailing Address - Street 2:DEPT 1882
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35287-1882
Mailing Address - Country:US
Mailing Address - Phone:662-227-9991
Mailing Address - Fax:662-227-9996
Practice Address - Street 1:1300 SUNSET DR
Practice Address - Street 2:SUITE W
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4086
Practice Address - Country:US
Practice Address - Phone:662-227-9991
Practice Address - Fax:662-227-9996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15354207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty