Healthcare Provider Details

I. General information

NPI: 1790909851
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

484 COUNTY LINE RD W STE 240 & 1000
WESTERVILLE OH
43082-7080
US

IV. Provider business mailing address

423 E TOWN ST
COLUMBUS OH
43215-4748
US

V. Phone/Fax

Practice location:
  • Phone: 614-899-0808
  • Fax: 614-899-0938
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