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NPI Code Detail

MEDICARE: SOUTH CENTRAL HEART GROUP INC

MEDICARE: SOUTH CENTRAL HEART GROUP INC
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
1207RI0011XInterventional Cardiology Physician
2363A00000XPhysician Assistant
3207RC0000XCardiovascular Disease Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14074604OTHERTNBLUECROSS BLUESHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700836202
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH CENTRAL HEART GROUP INC
Provider Business Mailing Address
First Line : 854 W JAMES CAMPBELL BLVD
Second Line : SUITE 303A
City : COLUMBIA
State : TN
Zip : 38401-4659
Country : US
Telephone Number : 931-540-4255
Fax Number : 931-490-4654
Provider Business Practice Location Address
First Line : 1220 TROTWOOD AVE
Second Line : SUITE 401
City : COLUMBIA
State : TN
Zip : 38401-6433
Country : US
Telephone Number : 931-388-8622
Fax Number : 931-388-8227
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. GARY TODD HILL
Credential :
Telephone Number : 931-540-4255
Provider Enumeration Date : 05/12/2006
Last Update Date : 04/04/2008

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Directions to “SOUTH CENTRAL HEART GROUP INC ” Practice Location

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