1184955684 NPI number — COLUMBIA CARDIOLOGY, LLC

Table of content: (NPI 1184955684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184955684 NPI number — COLUMBIA CARDIOLOGY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBIA CARDIOLOGY, 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:
1184955684
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4187
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29240-4187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-744-4900
Provider Business Mailing Address Fax Number:
803-744-2621

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 THE COMMON AT LUGOFF
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUGOFF
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29078-8725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-744-4900
Provider Business Practice Location Address Fax Number:
803-744-2621
Provider Enumeration Date:
01/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
B
Authorized Official Title or Position:
BUSINESS OFFICE SUPERVISOR
Authorized Official Telephone Number:
803-744-2612

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GP3493 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: CJ9082 . This is a "RR MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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