Provider Demographics
NPI:1295784148
Name:CARDIOVASCULAR ASSOCIATES OF NORTH ALABAMA, P.C.
Entity type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATES OF NORTH ALABAMA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-702-7555
Mailing Address - Street 1:1280 COLUMBIANA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1642
Mailing Address - Country:US
Mailing Address - Phone:205-599-3540
Mailing Address - Fax:205-599-6333
Practice Address - Street 1:1280 COLUMBIANA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-1642
Practice Address - Country:US
Practice Address - Phone:205-599-3540
Practice Address - Fax:205-599-6333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCL9167OtherRAILROAD
AL000060026Medicaid
AL000060026Medicaid