MEDICARE: HEART SOUTH CARDIOVASCULAR GROUP, P.C.

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	:	1588641005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART SOUTH CARDIOVASCULAR GROUP, P.C.

Provider Business Mailing Address
First Line	:	1022 1ST ST N
Second Line	:	SUITE 500
City	:	ALABASTER
State	:	AL
Zip	:	35007-8706
Country	:	US
Telephone Number	:	205-663-5775
Fax Number	:	205-664-2112

Provider Business Practice Location Address
First Line	:	1022 1ST ST N
Second Line	:	SUITE 500
City	:	ALABASTER
State	:	AL
Zip	:	35007-8706
Country	:	US
Telephone Number	:	205-663-5775
Fax Number	:	205-664-2112

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN DAVID MCBRAYER
Credential	:	MD
Telephone Number	:	205-663-5775

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	08/31/2007

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