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General NPI Number Information
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NPI Number | 1598827420
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Entity Type | Organization
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Legal Business Name | EAST ALABAMA CARDIAC AND THORACIC SURGERY
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 10/16/2009
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Provider Practice Location Address
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Address Line | 2000 PEPPERELL PKWY
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City | OPELIKA
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State | AL
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Zip | 36801-5452
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Country | US
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Telephone | 334-528-1720
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Fax | 334-528-1693
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Provider Business Mailing Address
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Address Line | 2000 PEPPERELL PKWY PO BOX 2740
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City | OPELIKA
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State | AL
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Zip | 36801-5452
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Country | US
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Telephone | 334-528-1720
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Fax | 334-528-1693
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KELLY MARIE FARR
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Credential |
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Telephone | 334-528-1720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 22312
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 19855
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License Number State | AL
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