Provider Demographics
NPI:1578621736
Name:CARDIOLOGY OF CENTRAL ALABAMA, P.C.
Entity Type:Organization
Organization Name:CARDIOLOGY OF CENTRAL ALABAMA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SUBLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-234-2644
Mailing Address - Street 1:3368 HIGHWAY 280
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-3393
Mailing Address - Country:US
Mailing Address - Phone:256-234-2644
Mailing Address - Fax:256-234-2704
Practice Address - Street 1:3368 HIGHWAY 280
Practice Address - Street 2:SUITE 130
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3393
Practice Address - Country:US
Practice Address - Phone:256-234-2644
Practice Address - Fax:256-234-2704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD15380207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529900750Medicaid
AL529900750Medicaid
AL051007980SUBMedicare ID - Type Unspecified