Healthcare Provider Details

I. General information

NPI: 1003834672
Provider Name (Legal Business Name): SOUTHEASTERN CARDIOVASCULAR ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2431 W MAIN ST SUITE 1001
DOTHAN AL
36301-1217
US

IV. Provider business mailing address

2431 W MAIN ST SUITE 1001
DOTHAN AL
36301-1217
US

V. Phone/Fax

Practice location:
  • Phone: 334-794-2825
  • Fax: 334-793-5050
Mailing address:
  • Phone: 334-794-2825
  • Fax: 334-793-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number00007208
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number00007208
License Number StateAL

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. EDWARD J PLANZ JR.
Title or Position: PRESIDENT
Credential: M. D.
Phone: 334-794-2825