Provider Demographics
NPI:1053791764
Name:MULTI-SPECIALTY CARE-CARDIAC CARE IN SOUTH, LLC
Entity type:Organization
Organization Name:MULTI-SPECIALTY CARE-CARDIAC CARE IN SOUTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-526-2200
Mailing Address - Street 1:4490 AL HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:VALLEY GRANDE
Mailing Address - State:AL
Mailing Address - Zip Code:36701-0501
Mailing Address - Country:US
Mailing Address - Phone:332-526-2200
Mailing Address - Fax:
Practice Address - Street 1:4490 AL HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:VALLEY GRANDE
Practice Address - State:AL
Practice Address - Zip Code:36701-0501
Practice Address - Country:US
Practice Address - Phone:332-526-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty