Healthcare Provider Details

I. General information

NPI: 1245252113
Provider Name (Legal Business Name): FOOTHILLS CARDIOLOGY ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 FLEETWOOD DR
EASLEY SC
29640-2019
US

IV. Provider business mailing address

129 FLEETWOOD DR
EASLEY SC
29640-2019
US

V. Phone/Fax

Practice location:
  • Phone: 864-855-4255
  • Fax: 864-855-4439
Mailing address:
  • Phone: 864-855-4255
  • Fax: 864-855-4439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. PAMELA E PELT
Title or Position: OFFICE MANAGER
Credential:
Phone: 864-855-4255