Healthcare Provider Details

I. General information

NPI: 1104088707
Provider Name (Legal Business Name): SOUTH CAROLINA HEART CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 NORTH ST
BAMBERG SC
29003-1319
US

IV. Provider business mailing address

PO BOX 99
COLUMBIA SC
29202-0099
US

V. Phone/Fax

Practice location:
  • Phone: 803-245-6290
  • Fax: 803-245-6291
Mailing address:
  • Phone: 803-254-3278
  • Fax: 803-376-8010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KATHY KOENIG
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 803-254-3278