Healthcare Provider Details

I. General information

NPI: 1376050534
Provider Name (Legal Business Name): KHOURY CARDIOLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 SALUDA AVE
COLUMBIA SC
29205-3080
US

IV. Provider business mailing address

151 SALUDA AVE
COLUMBIA SC
29205-3080
US

V. Phone/Fax

Practice location:
  • Phone: 803-788-8848
  • Fax:
Mailing address:
  • Phone: 803-788-8848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD13066
License Number StateSC

VIII. Authorized Official

Name: LEON J KHOURY JR.
Title or Position: PRESIDENT / OWNER
Credential: MD
Phone: 803-788-8848