Basic Information
| Provider Information | |||||||||
| NPI: | 1336683135 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HECA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2007 GALLATIN ST SW | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565336488 | ||||||||
| FaxNumber: | 2565347372 | ||||||||
| Practice Location | |||||||||
| Address1: | 119 LONGWOOD DR SW | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565336488 | ||||||||
| FaxNumber: | 2565347372 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2016 | ||||||||
| LastUpdateDate: | 12/13/2016 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | WAYNE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2565336488 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THE HUNTSVILLE ENDOSCOPY CENTER | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.