Healthcare Provider Details

I. General information

NPI: 1316239346
Provider Name (Legal Business Name): UNIVERSITY CARDIOLOGY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 SAINT SEBASTIAN WAY STE 311
AUGUSTA GA
30901-2653
US

IV. Provider business mailing address

820 SAINT SEBASTIAN WAY STE 7A
AUGUSTA GA
30901-2641
US

V. Phone/Fax

Practice location:
  • Phone: 706-724-3473
  • Fax: 706-722-7307
Mailing address:
  • Phone: 706-774-7263
  • Fax: 706-774-7230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVE BELKOSKI
Title or Position: EXECUTIVE VP/CFO
Credential:
Phone: 706-724-3473