Provider Demographics
NPI:1407054620
Name:SA CASSIDY MD PC
Entity Type:Organization
Organization Name:SA CASSIDY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASSIDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-215-3490
Mailing Address - Street 1:3368 HIGHWAY 280
Mailing Address - Street 2:SUITE 207
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-3393
Mailing Address - Country:US
Mailing Address - Phone:256-215-3490
Mailing Address - Fax:256-215-3488
Practice Address - Street 1:3368 HIGHWAY 280
Practice Address - Street 2:SUITE 207
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3393
Practice Address - Country:US
Practice Address - Phone:256-215-3490
Practice Address - Fax:256-215-3488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025351208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G90521Medicare UPIN