MEDICARE: CARDIO STAT INC

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	291U00000X	Clinical Medical Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750388070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIO STAT INC

Provider Business Mailing Address
First Line	:	PO BOX 1928
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29071-1928
Country	:	US
Telephone Number	:	803-957-0500
Fax Number	:	803-358-1736

Provider Business Practice Location Address
First Line	:	171A MONROE LN
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-3904
Country	:	US
Telephone Number	:	803-358-6715
Fax Number	:	803-358-1715

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MRS. CHRISTINA M JEFFCOAT
Credential	:
Telephone Number	:	803-957-0500

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	03/01/2016

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Directions to “CARDIO STAT INC ” Practice Location

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