Organization
SANFORD CARDIOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CYRUS J FAIRCLOTH II (CEO)
(910) 295-5511
Entity
Organization
Contact information
Practice address
110 FIELDS DR, SUITE A, SANFORD, NC 27330-5072
(919) 777-9005
(919) 708-1550
Mailing address
110 FIELDS DR, SUITE A, SANFORD, NC 27330-5072
(919) 777-9005
(919) 708-1550
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
123151
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020VA
BC/BS NC
—
05
—
5950478
—
NC
01
—
DC4848
PALMETTO GBA GROUP#
NC
Enumeration date
05/27/2006
Last updated
02/26/2010
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