Healthcare Provider Details

I. General information

NPI: 1245266139
Provider Name (Legal Business Name): COLUMBIA HEART CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 12/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 RICHLAND MEDICAL PARK DRIVE. SUITE 300
COLUMBIA SC
29203
US

IV. Provider business mailing address

8 RICHLAND MEDICAL PARK DRIVE. SUITE 300
COLUMBIA SC
29203
US

V. Phone/Fax

Practice location:
  • Phone: 803-744-8426
  • Fax: 803-744-4731
Mailing address:
  • Phone: 803-744-8426
  • Fax: 803-744-4731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: LORA HAVER
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 803-744-8426