Provider Demographics
NPI:1184955684
Name:COLUMBIA CARDIOLOGY, LLC
Entity type:Organization
Organization Name:COLUMBIA CARDIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:B
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-744-2612
Mailing Address - Street 1:PO BOX 4187
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29240-4187
Mailing Address - Country:US
Mailing Address - Phone:803-744-4900
Mailing Address - Fax:803-744-2621
Practice Address - Street 1:1 THE COMMON AT LUGOFF
Practice Address - Street 2:
Practice Address - City:LUGOFF
Practice Address - State:SC
Practice Address - Zip Code:29078-8725
Practice Address - Country:US
Practice Address - Phone:803-744-4900
Practice Address - Fax:803-744-2621
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBIA CARDIOLOGY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-22
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3493Medicaid
SCCJ9082OtherRR MEDICARE
SC7364Medicare UPIN