Organization
PROVIDENCE CARDIOLOGY LLC
Active
Parent organization
PROVIDENCE CARDIOLOGY
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE CARDIOLOGY
Authorized official
LARRY ELLIS (CEO)
(803) 254-3278
Entity
Organization
Contact information
Practice address
114 GATEWAY CORPORATE BLVD, SUITE 330, COLUMBIA, SC 29203-9740
(803) 254-3278
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
—
SC
Other
Enumeration date
08/16/2012
Last updated
08/16/2012
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