MEDICARE: COLUMBIA CARDIOLOGY

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	207R00000X	Internal Medicine Physician

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	:	1750544912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBIA CARDIOLOGY

Provider Business Mailing Address
First Line	:	PO BOX 4187
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29240-4187
Country	:	US
Telephone Number	:	803-744-4900
Fax Number	:	803-744-2622

Provider Business Practice Location Address
First Line	:	114 GATEWAY BLVD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-0000
Country	:	US
Telephone Number	:	803-744-4900
Fax Number	:	803-744-2622

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	TRACY BUTLER BROWN
Credential	:
Telephone Number	:	803-744-2612

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	07/08/2008

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Directions to “COLUMBIA CARDIOLOGY ” Practice Location

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