Basic Information
| Provider Information | |||||||||
| NPI: | 1336132281 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUNTSVILLE CARDIOTHORACIC SURGEONS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 SIVLEY RD SW | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358015134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565331077 | ||||||||
| FaxNumber: | 2565333379 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 SIVLEY RD SW | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358015134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565331077 | ||||||||
| FaxNumber: | 2565333379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2005 | ||||||||
| LastUpdateDate: | 07/24/2007 | ||||||||
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| AuthorizedOfficialLastName: | CLAY | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | LLOYD | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2565331077 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.