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General NPI Number Information
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NPI Number | 1376050534
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Entity Type | Organization
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Legal Business Name | KHOURY CARDIOLOGY, PA
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Dates
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Enumeration Date | 01/09/2018
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Last Update Date | 10/11/2019
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Provider Practice Location Address
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Address Line | 151 SALUDA AVE
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City | COLUMBIA
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State | SC
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Zip | 29205-3080
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Country | US
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Telephone | 803-788-8848
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Fax |
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Provider Business Mailing Address
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Address Line | 151 SALUDA AVE
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City | COLUMBIA
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State | SC
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Zip | 29205-3080
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Country | US
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Telephone | 803-788-8848
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Fax |
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Authorized Official
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Title or Position | PRESIDENT / OWNER
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Name | LEON J KHOURY JR.
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Credential | MD
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Telephone | 803-788-8848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MD13066
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License Number State | SC
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