Healthcare Provider Details

I. General information

NPI: 1497770291
Provider Name (Legal Business Name): SUNSET CARDIOVASCULAR SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 SUNSET DR SUITE W
GRENADA MS
38901-4086
US

IV. Provider business mailing address

PO BOX 2153 DEPT 1882
BIRMINGHAM AL
38148-0989
US

V. Phone/Fax

Practice location:
  • Phone: 662-227-9991
  • Fax: 662-227-9996
Mailing address:
  • Phone: 662-227-9991
  • Fax: 662-227-9996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number15354
License Number StateMS

VIII. Authorized Official

Name: DR. JOHN EDWARD SEIBEL JR.
Title or Position: OWNER
Credential: MD
Phone: 901-767-3123