Healthcare Provider Details

I. General information

NPI: 1629264734
Provider Name (Legal Business Name): PEDIATRIC CARDIOLOGY ASSO. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 WILLIAMS AVE SW SUITE 1121
HUNTSVILLE AL
35801-6012
US

IV. Provider business mailing address

303 WILLIAMS AVE SW SUITE 1121
HUNTSVILLE AL
35801-6012
US

V. Phone/Fax

Practice location:
  • Phone: 256-536-1081
  • Fax: 256-536-1082
Mailing address:
  • Phone: 256-536-1081
  • Fax: 256-536-1082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number12400
License Number StateAL

VIII. Authorized Official

Name: DR. PAUL ISRAEL
Title or Position: OWNER
Credential:
Phone: 256-536-1081