Healthcare Provider Details

I. General information

NPI: 1407822786
Provider Name (Legal Business Name): TWIN CITY CARDIOLOGY ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 BECKER DR
ROANOKE RAPIDS NC
27870-3207
US

IV. Provider business mailing address

PO BOX 340
ROANOKE RAPIDS NC
27870-0340
US

V. Phone/Fax

Practice location:
  • Phone: 252-537-9268
  • Fax:
Mailing address:
  • Phone: 252-537-9268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number StateNC

VIII. Authorized Official

Name: MRS. ANNIE K ANTONY
Title or Position: OFFICE MANAGER
Credential:
Phone: 252-537-9268