Healthcare Provider Details

I. General information

NPI: 1699104794
Provider Name (Legal Business Name): CARDIAC AND VASCULAR CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 LEIGHTON AVE
ANNISTON AL
36207-4610
US

IV. Provider business mailing address

PO BOX 1739
ANNISTON AL
36202-1739
US

V. Phone/Fax

Practice location:
  • Phone: 256-237-0025
  • Fax: 256-237-4795
Mailing address:
  • Phone: 256-237-0025
  • Fax: 256-237-4795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number19196
License Number StateAL

VIII. Authorized Official

Name: OSITA ONYEKWERE
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 256-237-0025