Provider Demographics
NPI:1093765398
Name:CATAWBA PIEDMONT CARDIOTHORACIC SURGERY LLC
Entity Type:Organization
Organization Name:CATAWBA PIEDMONT CARDIOTHORACIC SURGERY LLC
Other - Org Name:CATAWBA CARDIOTHORACIC SURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-893-2030
Mailing Address - Street 1:PO BOX 741335
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1335
Mailing Address - Country:US
Mailing Address - Phone:803-324-1950
Mailing Address - Fax:803-324-1933
Practice Address - Street 1:200 SOUTH HERLONG AVE
Practice Address - Street 2:SUITE E1
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1587
Practice Address - Country:US
Practice Address - Phone:803-324-1950
Practice Address - Fax:803-324-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF1815OtherRAILROAD MEDICARE
SCGP4378Medicaid
DF1815Medicare PIN
SCGP4378Medicaid