=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922497312
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL MCKINNEY CARDIOLOGY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2015
-----------------------------------------------------
Last Update Date | 01/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1110 LAKEVIEW CRES
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35205-1119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-568-9526
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1110 LAKEVIEW CRES
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35205-1119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-568-9526
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MICHAEL EUGENE MCKINNEY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 205-542-5340
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 12095
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------