=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356404362
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL ALABAMA THORACIC & CARDIOVASCULAR SURGERY, P. A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2006
-----------------------------------------------------
Last Update Date | 11/15/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2055 E SOUTH BLVD SUITE 301
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36116-2001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-286-9500
-----------------------------------------------------
Fax | 334-286-9380
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2055 E SOUTH BLVD SUITE 301
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36116-2001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-286-9500
-----------------------------------------------------
Fax | 334-286-9380
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. PAUL LOUIS CAMMACK
-----------------------------------------------------
Credential | M. D.
-----------------------------------------------------
Telephone | 334-286-9500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0129X
-----------------------------------------------------
Taxonomy Name | Vascular Surgery Physician
-----------------------------------------------------
License Number | 9494
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------