MEDICARE: CARDIOTHORACIC SURGERY OF CHARLESTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician

General Provider Information

NPI Number	:	1548262587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOTHORACIC SURGERY OF CHARLESTON

Provider Business Mailing Address
First Line	:	125 DOUGHTY ST
Second Line	:	SUITE 690
City	:	CHARLESTON
State	:	SC
Zip	:	29403-5736
Country	:	US
Telephone Number	:	843-720-8490
Fax Number	:	843-727-3602

Provider Business Practice Location Address
First Line	:	125 DOUGHTY ST
Second Line	:	SUITE 690
City	:	CHARLESTON
State	:	SC
Zip	:	29403-5736
Country	:	US
Telephone Number	:	843-720-8490
Fax Number	:	843-727-3602

Authorized Official
Title or Position	:	BILLING ADMINISTRATOR
Name	:	MRS. JEAN JONES
Credential	:
Telephone Number	:	843-720-8490

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	08/22/2020

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