MEDICARE: MULTI-SPECIALTY CARE-CARDIAC CARE IN SOUTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1053791764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MULTI-SPECIALTY CARE-CARDIAC CARE IN SOUTH, LLC

Provider Business Mailing Address
First Line	:	4490 AL HIGHWAY 22
Second Line	:
City	:	VALLEY GRANDE
State	:	AL
Zip	:	36701-0501
Country	:	US
Telephone Number	:	332-526-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	4490 AL HIGHWAY 22
Second Line	:
City	:	VALLEY GRANDE
State	:	AL
Zip	:	36701-0501
Country	:	US
Telephone Number	:	332-526-2200
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ OFFICE MANAGER
Name	:	SAMIRA AMIN
Credential	:
Telephone Number	:	334-526-2200

Provider Enumeration Date	:	06/08/2015
Last Update Date	:	06/08/2015

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