NPIMap

Organization Active NPI

Southeast Cardiology Clinic Inc.

  • Cardiovascular Disease Physician
  • Dothan, AL
National Provider Identifier
1285790915
Registry record updated Aug 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
SOUTHEAST CARDIOLOGY CLINIC INC.
Practice address
1150 Ross Clark Cir
Dothan, AL 36301-3022
Phone
(334) 712-1929
Fax
(334) 712-2799
NPI assigned
Dec 28, 2006
Last updated
Aug 3, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Donna Bridwell
Title
Insurance Supervisor
Phone
(334) 712-1929

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X NU Primary

Addresses

Primary practice location

1150 Ross Clark Cir
Dothan, AL 36301-3022

Mailing address

1150 Ross Clark Cir
Dothan, AL 36301-3022
Phone (334) 712-1929

Other identifiers 2

IdentifierTypeStateIssuer
258388700MedicaidFL
529301110MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, AL, FL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040607000494 GA Part B Supplier - Clinic/Group Practice 9234111899 Receives reassigned benefits from 13 practitioners
Practice locations: Blakely, GA; Donalsonville, GA
O20050621001149 AL Part B Supplier - Clinic/Group Practice 9234111899 Receives reassigned benefits from 12 practitioners
Practice locations: Troy, AL; Dothan, AL; Ozark, AL; Opp, AL; Geneva, AL; Eufaula, AL; Enterprise, AL; Elba, AL…
O20051101000786 FL Part B Supplier - Clinic/Group Practice 9234111899 Receives reassigned benefits from 13 practitioners
Practice locations: Marianna, FL

National Provider Directory

National Provider Directory

Locations

1118 Ross Clark Cir
Ste 101
Dothan, AL 36301
Phone (334) 677-1690

1150 Ross Clark Cir
Dothan, AL 36301
Phone (334) 712-2770

2020 Alexander Dr
Dothan, AL 36301
Phone (334) 673-4166

409 N Main St
Enterprise, AL 36330
Phone (334) 393-8252

409 N Main St
#A
Enterprise, AL 36330

409 N Main St
Ste A
Enterprise, AL 36330

3028 4th St
Marianna, FL 32446
Phone (850) 526-2225

4230 Hospital Dr
Ste 101
Marianna, FL 32446
Phone (850) 526-6607

4250 Hospital Dr
Marianna, FL 32446
Phone (850) 526-2200

4250 Hospital Dr
Ste 101
Marianna, FL 32446

4257 Lafayette St
Marianna, FL 32446
Phone (850) 482-9488

1632 E Shotwell St
Bainbridge, GA 39819

11045 Columbia St
Blakely, GA 39823
Phone (228) 723-4313

11168 Columbia St
Ste A
Blakely, GA 39823
Phone (229) 723-2115

700 N Wiley Ave
Donalsonville, GA 39845

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312329600000",
    "number": "1285790915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 ROSS CLARK CIR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363013022",
            "telephone_number": "334-712-1929",
            "fax_number": "334-712-2799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 ROSS CLARK CIR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363013022",
            "telephone_number": "334-712-1929",
            "fax_number": "334-712-2799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST CARDIOLOGY CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2011-08-03",
        "status": "A",
        "authorized_official_last_name": "BRIDWELL",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "INSURANCE SUPERVISOR",
        "authorized_official_telephone_number": "334-712-1929",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "258388700",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529301110",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.