Healthcare Provider Details

I. General information

NPI: 1033596515
Provider Name (Legal Business Name): PREMIER CARDIOLOGY CONSULTANTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 ROSS CLARK CIR STE 704
DOTHAN AL
36301-3001
US

IV. Provider business mailing address

1118 ROSS CLARK CIR STE 704
DOTHAN AL
36301-3001
US

V. Phone/Fax

Practice location:
  • Phone: 334-699-6396
  • Fax: 334-699-6398
Mailing address:
  • Phone: 334-699-6396
  • Fax: 334-699-6398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD 29518
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier014883400
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name: DR. NIDAL A YUNIS
Title or Position: MD / OWNER
Credential: MD
Phone: 334-699-6396