Provider Demographics
NPI:1588641005
Name:HEART SOUTH CARDIOVASCULAR GROUP, P.C.
Entity Type:Organization
Organization Name:HEART SOUTH CARDIOVASCULAR GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MCBRAYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-663-5775
Mailing Address - Street 1:1022 1ST ST N
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8706
Mailing Address - Country:US
Mailing Address - Phone:205-663-5775
Mailing Address - Fax:205-664-2112
Practice Address - Street 1:1022 1ST ST N
Practice Address - Street 2:SUITE 500
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8706
Practice Address - Country:US
Practice Address - Phone:205-663-5775
Practice Address - Fax:205-664-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALJ154Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER