Provider Demographics
NPI:1790057420
Name:BAMA HEART DOC, P.C.
Entity Type:Organization
Organization Name:BAMA HEART DOC, P.C.
Other - Org Name:ALABAMA HEART AND VASCULAR MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:P
Authorized Official - Last Name:HEMSTREET
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:205-342-2552
Mailing Address - Street 1:100 RICE MINE ROAD LOOP
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2425
Mailing Address - Country:US
Mailing Address - Phone:205-342-2552
Mailing Address - Fax:205-345-8365
Practice Address - Street 1:100 RICE MINE ROAD LOOP
Practice Address - Street 2:SUITE 104
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2425
Practice Address - Country:US
Practice Address - Phone:205-342-2552
Practice Address - Fax:205-345-8365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty