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General NPI Number Information
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NPI Number | 1871048389
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Entity Type | Organization
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Legal Business Name | SOUTHERN CARDIO LLC
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Dates
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Enumeration Date | 08/25/2016
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Last Update Date | 08/25/2016
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Provider Practice Location Address
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Address Line | 7230 NW 20TH CT
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City | SUNRISE
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State | FL
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Zip | 33313-3806
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Country | US
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Telephone | 954-804-1864
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Fax | 954-742-0412
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Provider Business Mailing Address
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Address Line | 7230 NW 20TH CT
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City | SUNRISE
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State | FL
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Zip | 33313-3806
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Country | US
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Telephone | 954-804-1864
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Fax | 954-742-0412
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | WINSOME MCDONALD
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Credential |
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Telephone | 954-804-1864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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