Organization
PROVIDENCE CARDIOLOGY LLC
Active
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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