Healthcare Provider Details

I. General information

NPI: 1548262587
Provider Name (Legal Business Name): CARDIOTHORACIC SURGERY OF CHARLESTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 DOUGHTY ST SUITE 690
CHARLESTON SC
29403-5736
US

IV. Provider business mailing address

125 DOUGHTY ST SUITE 690
CHARLESTON SC
29403-5736
US

V. Phone/Fax

Practice location:
  • Phone: 843-720-8490
  • Fax: 843-727-3602
Mailing address:
  • Phone: 843-720-8490
  • Fax: 843-727-3602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JEAN JONES
Title or Position: BILLING ADMINISTRATOR
Credential:
Phone: 843-720-8490