Provider Demographics
NPI:1861666711
Name:CARDIOLOGY ASSOCIATES OF MOBILE INC
Entity Type:Organization
Organization Name:CARDIOLOGY ASSOCIATES OF MOBILE INC
Other - Org Name:CARDIOLOGY ASSOCIATES / EASTERN SHORE INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CHAIRMAN OF BOARD
Authorized Official - Prefix:DR
Authorized Official - First Name:GERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-607-9797
Mailing Address - Street 1:6701 AIRPORT BLVD
Mailing Address - Street 2:SUITE D-330
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6705
Mailing Address - Country:US
Mailing Address - Phone:251-607-9797
Mailing Address - Fax:
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:SUITE D-330
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6705
Practice Address - Country:US
Practice Address - Phone:251-607-9797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARDIOLOGY ASSOCIATES OF MOBILE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-22
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-38007OtherBLUE CROSS BLUE SHIELD
AL2510092OtherUNITED HEALTHCARE
MS0119053Medicaid
AL510-38007OtherBLUE CROSS BLUE SHIELD