Healthcare Provider Details

I. General information

NPI: 1447474598
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

4882 E MAIN ST STE 250
WHITEHALL OH
43213-3162
US

IV. Provider business mailing address

423 E TOWN ST
COLUMBUS OH
43215-4748
US

V. Phone/Fax

Practice location:
  • Phone: 614-464-0884
  • Fax: 614-464-3440
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 State

VIII. Authorized Official

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