| Cardinal Medical Group Llc | |
|
185 Whitesport Dr Sw Ste 1 Huntsville AL 35801-6487 | |
| (562) 131-0312 | |
| (800) 765-1229 |
| Full Name | Cardinal Medical Group Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 185 Whitesport Dr Sw Ste 1, Huntsville, Alabama |
| Authorized Official Name and Position | Sunitha A Ghanta (MD/OWNER) |
| Authorized Official Contact | 2562131031 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cardinal Medical Group Llc 185 Whitesport Dr Sw Ste 1 Huntsville AL 35801-6487 Ph: (256) 213-1031 | Cardinal Medical Group Llc 185 Whitesport Dr Sw Ste 1 Huntsville AL 35801-6487 Ph: (562) 131-0312 |
| NPI Number | 1457654840 |
|---|---|
| Provider Enumeration Date | 12/07/2010 |
| Last Update Date | 07/27/2022 |
| Medicare PECOS PAC ID | 4587845193 |
|---|---|
| Medicare Enrollment ID | O20110301001001 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457654840 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 29794 (Alabama) | Primary |
| Provider Name | Sunitha A Ghanta |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194935155 PECOS PAC ID: 2567594880 Enrollment ID: I20100721000646 |
| Provider Name | Heather Lauren Simmons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265192959 PECOS PAC ID: 6002200813 Enrollment ID: I20220221001641 |
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