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General NPI Number Information
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NPI Number | 1821112673
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Entity Type | Organization
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Legal Business Name | BRUNSWICK CARDIOLOGY
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 20 MEDICAL CAMPUS DR NW STE 203
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City | SUPPLY
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State | NC
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Zip | 28462-4094
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Country | US
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Telephone | 910-755-7192
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Fax | 910-755-7194
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Provider Business Mailing Address
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Address Line | PO BOX 427
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City | SUPPLY
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State | NC
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Zip | 28462-0427
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Country | US
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Telephone | 910-755-7192
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Fax | 910-755-7194
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Authorized Official
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Title or Position | OFFICE ASSISTANT
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Name | REBECCA LITTLE
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Credential |
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Telephone | 910-755-7192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35196
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License Number State | NC
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