MEDICARE: CARDIOVASCULAR INSTITUTE

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	207RC0000X	Cardiovascular Disease Physician	12677	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	:	1891745709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOVASCULAR INSTITUTE

Provider Business Mailing Address
First Line	:	1175 COOK RD
Second Line	:	SUITE 225
City	:	ORANGEBURG
State	:	SC
Zip	:	29118-8201
Country	:	US
Telephone Number	:	803-534-8723
Fax Number	:	803-536-0030

Provider Business Practice Location Address
First Line	:	1175 COOK RD
Second Line	:	SUITE 225
City	:	ORANGEBURG
State	:	SC
Zip	:	29118-8201
Country	:	US
Telephone Number	:	803-534-8723
Fax Number	:	803-536-0030

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	MARK JOSEPH KRZYSTON
Credential	:	M.D.
Telephone Number	:	803-534-8723

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	12/13/2010

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Directions to “CARDIOVASCULAR INSTITUTE ” Practice Location

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