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General NPI Number Information
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NPI Number | 1891745709
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Entity Type | Organization
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Legal Business Name | CARDIOVASCULAR INSTITUTE
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 12/13/2010
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Provider Practice Location Address
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Address Line | 1175 COOK RD SUITE 225
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City | ORANGEBURG
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State | SC
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Zip | 29118-8201
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Country | US
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Telephone | 803-534-8723
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Fax | 803-536-0030
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Provider Business Mailing Address
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Address Line | 1175 COOK RD SUITE 225
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City | ORANGEBURG
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State | SC
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Zip | 29118-8201
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Country | US
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Telephone | 803-534-8723
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Fax | 803-536-0030
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MARK JOSEPH KRZYSTON
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Credential | M.D.
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Telephone | 803-534-8723
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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 | 12677
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License Number State | SC
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