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General NPI Number Information
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NPI Number | 1710796446
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Entity Type | Organization
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Legal Business Name | SOUTHPARK HEART & RHYTHM CENTER LLC
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 445 CHARLES H DIMMOCK PKWY STE 102
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-2990
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Country | US
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Telephone | 804-823-2375
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Fax | 804-495-4955
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Provider Business Mailing Address
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Address Line | 445 CHARLES H DIMMOCK PKWY STE 100
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-2990
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Country | US
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Telephone | 804-823-2375
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Fax | 804-495-4955
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Authorized Official
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Title or Position | CEO
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Name | MITESH AMIN
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Credential | MD
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Telephone | 804-400-1322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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