MEDICARE: HUNTSVILLE HEART SPECIALISTS

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	:	1356865216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUNTSVILLE HEART SPECIALISTS

Provider Business Mailing Address
First Line	:	101 BOB WALLACE AVE SW
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-3847
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 BOB WALLACE AVE SW
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-3847
Country	:	US
Telephone Number	:	256-532-1888
Fax Number	:

Authorized Official
Title or Position	:	MD/OWNER
Name	:	CHARLES RANDALL BURNS
Credential	:	MD
Telephone Number	:	256-520-1841

Provider Enumeration Date	:	08/01/2017
Last Update Date	:	08/01/2017

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