Basic Information
| Provider Information | |||||||||
| NPI: | 1609937945 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUNTSVILLE CARDIOVASCULAR CLINIC, P. C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4601 WHITESBURG DR S | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358021676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568801050 | ||||||||
| FaxNumber: | 2568807477 | ||||||||
| Practice Location | |||||||||
| Address1: | 4601 WHITESBURG DR S | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358021676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568801050 | ||||||||
| FaxNumber: | 2568807477 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 11/29/2021 | ||||||||
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| AuthorizedOfficialLastName: | RYDER | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | REVENUE CYCLE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2562134679 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
No ID Information.