Provider Demographics
NPI:1356404362
Name:CENTRAL ALABAMA THORACIC & CARDIOVASCULAR SURGERY, P. A.
Entity type:Organization
Organization Name:CENTRAL ALABAMA THORACIC & CARDIOVASCULAR SURGERY, P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:CAMMACK
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:334-286-9500
Mailing Address - Street 1:2055 E SOUTH BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-2001
Mailing Address - Country:US
Mailing Address - Phone:334-286-9500
Mailing Address - Fax:334-286-9380
Practice Address - Street 1:2055 E SOUTH BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2001
Practice Address - Country:US
Practice Address - Phone:334-286-9500
Practice Address - Fax:334-286-9380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL94942086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACI0175OtherRRMC-PIN
D523Medicare PIN