Providence Cardiology LLC

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

Legal business name

PROVIDENCE CARDIOLOGY LLC

Practice address

3103 Sunset Blvd
West Columbia, SC 29169-4817

Phone

(803) 794-3950

Fax

(803) 739-1485

NPI assigned

Sep 8, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kathleen L Koenig

Title

Chief Financial Officer

Phone

(803) 254-3278

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Providence Cardiology Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339113600000",
    "number": "1083995641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 LAUREL ST",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292041018",
            "telephone_number": "803-254-3278",
            "fax_number": "803-376-8010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3103 SUNSET BLVD",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291694817",
            "telephone_number": "803-794-3950",
            "fax_number": "803-739-1485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE CARDIOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-08",
        "last_updated": "2012-06-08",
        "status": "A",
        "authorized_official_last_name": "KOENIG",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "803-254-3278"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP5822",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Cardiology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in West Columbia, SC
• Cardiovascular Disease Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.