Organization
PROVIDENCE CARDIOLOGY LLC
Active
Other names
Providence Cardiology
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN L KOENIG (CHIEF FINANCIAL OFFICER)
(803) 254-3278
Entity
Organization
Contact information
Practice address
3103 SUNSET BLVD, WEST COLUMBIA, SC 29169-4817
(803) 794-3950
(803) 739-1485
Mailing address
2001 LAUREL ST, COLUMBIA, SC 29204-1018
(803) 254-3278
(803) 376-8010
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP5822
—
SC
Enumeration date
09/08/2011
Last updated
06/08/2012
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