MEDICARE: SC CARDIOVASCULAR ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	12973	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508927591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SC CARDIOVASCULAR ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	102 ASHLEY AVE APT A
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29401-6206
Country	:	US
Telephone Number	:	843-654-7337
Fax Number	:	843-654-7336

Provider Business Practice Location Address
First Line	:	1156 BOWMAN RD UNIT 103
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-3803
Country	:	US
Telephone Number	:	843-654-7337
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL LAMAR EDWARDS
Credential	:	MD
Telephone Number	:	843-654-7337

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	03/21/2025

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