1619216058 NPI number — ST. JOSEPH'S CARDIOLOGY GROUP, LLC

Table of content: (NPI 1619216058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619216058 NPI number — ST. JOSEPH'S CARDIOLOGY GROUP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. JOSEPH'S CARDIOLOGY GROUP, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619216058
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
836 E. 65TH STREET
Provider Second Line Business Mailing Address:
SUITE 20
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-819-7878
Provider Business Mailing Address Fax Number:
912-819-5044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11700 MERCY BLVD.
Provider Second Line Business Practice Location Address:
PLAZA D #6
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-927-3434
Provider Business Practice Location Address Fax Number:
912-927-5016
Provider Enumeration Date:
02/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HINCHEY
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
912-819-6901

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003162061A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com