Healthcare Provider Details

I. General information

NPI: 1700836202
Provider Name (Legal Business Name): SOUTH CENTRAL HEART GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 TROTWOOD AVE SUITE 401
COLUMBIA TN
38401-6433
US

IV. Provider business mailing address

854 W JAMES CAMPBELL BLVD SUITE 303A
COLUMBIA TN
38401-4659
US

V. Phone/Fax

Practice location:
  • Phone: 931-388-8622
  • Fax: 931-388-8227
Mailing address:
  • Phone: 931-540-4255
  • Fax: 931-490-4654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY TODD HILL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 931-540-4255