Organization
PROVIDENCE CARDIOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY KOENIG (CFO)
(803) 254-3278
Entity
Organization
Contact information
Practice address
2001 LAUREL ST, COLUMBIA, SC 29204-1018
(803) 254-3278
(803) 376-8010
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
—
—
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
207UN0901X
Nuclear Cardiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PC3787
—
SC
Enumeration date
09/06/2011
Last updated
09/06/2011
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