NPIMap

Organization Active NPI

Diagnostic and Interventional Cardiology Associates, P.a

  • Cardiovascular Disease Physician
  • Columbia, SC
National Provider Identifier
1396897286
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
DIAGNOSTIC AND INTERVENTIONAL CARDIOLOGY ASSOCIATES, P.A
Practice address
2753 Laurel St
Suite 2
Columbia, SC 29204-2021
Phone
(803) 252-1076
Fax
(803) 779-6339
NPI assigned
Jan 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Melvyn Vanroy Mahon, MD FACCNPI 1558372854
Title
Ceo Medical Doctor
Phone
(803) 252-1076

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X Primary

Addresses

Primary practice location

2753 Laurel St
Suite 2
Columbia, SC 29204-2021

Mailing address

2753 Laurel St
Suite 2
Columbia, SC 29204-2021
Phone (803) 252-1076

Other identifiers 3

IdentifierTypeStateIssuer
GP1217MedicaidSC
126205MedicaidSC
GP2525MedicaidSC

National Provider Directory

National Provider Directory

Locations

2753 Laurel St
Ste 2
Columbia, SC 29204
Phone (803) 252-1076

2753 Laurel St
Ste 11
Columbia, SC 29204

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1396897286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2753 LAUREL ST",
            "address_2": "SUITE 2",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292042021",
            "telephone_number": "803-252-1076",
            "fax_number": "803-779-6339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2753 LAUREL ST",
            "address_2": "SUITE 2",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292042021",
            "telephone_number": "803-252-1076",
            "fax_number": "803-779-6339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIAGNOSTIC AND INTERVENTIONAL CARDIOLOGY ASSOCIATES, P.A",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MAHON",
        "authorized_official_first_name": "MELVYN",
        "authorized_official_middle_name": "VANROY",
        "authorized_official_title_or_position": "CEO     MEDICAL DOCTOR",
        "authorized_official_telephone_number": "803-252-1076",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD    FACC"
    },
    "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": "GP1217",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126205",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP2525",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.