Healthcare Provider Details

I. General information

NPI: 1265656318
Provider Name (Legal Business Name): CAPITOL CITY CARDIOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 PLEASANTVILLE RD STE 101 & 102
LANCASTER OH
43130-3312
US

IV. Provider business mailing address

423 E TOWN ST
COLUMBUS OH
43215-4748
US

V. Phone/Fax

Practice location:
  • Phone: 740-653-7511
  • Fax: 740-653-7512
Mailing address:
  • Phone: 614-280-3916
  • Fax: 614-722-7945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. TIM HILL
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 614-280-3916