Healthcare Provider Details

I. General information

NPI: 1891735155
Provider Name (Legal Business Name): COLUMBIA CARDIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 LAUREL ST STE 260
COLUMBIA SC
29204-2033
US

IV. Provider business mailing address

PO BOX 4187
COLUMBIA SC
29240
US

V. Phone/Fax

Practice location:
  • Phone: 803-744-4900
  • Fax: 803-744-2621
Mailing address:
  • Phone: 803-744-4900
  • Fax: 803-744-2621

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: MRS. TRACY B BROWN
Title or Position: BUS OFFICE MGR
Credential:
Phone: 803-744-2612