Provider Demographics
NPI:1164646220
Name:CAPITOL CITY CARDIOLOGY, INC.
Entity Type:Organization
Organization Name:CAPITOL CITY CARDIOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-280-3916
Mailing Address - Street 1:423 E TOWN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4748
Mailing Address - Country:US
Mailing Address - Phone:614-280-3916
Mailing Address - Fax:614-722-7945
Practice Address - Street 1:2405 N COLUMBUS ST
Practice Address - Street 2:SUITE 130 AND 140
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8185
Practice Address - Country:US
Practice Address - Phone:614-280-3916
Practice Address - Fax:614-722-7945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2046940Medicaid
OHCA9331942Medicare PIN
OH2046940Medicaid