Provider Demographics
NPI:1235398678
Name:CARDIOVASCULAR DIAGNOSTIC SERVICES
Entity Type:Organization
Organization Name:CARDIOVASCULAR DIAGNOSTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:F
Authorized Official - Last Name:SCHWARZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-754-2600
Mailing Address - Street 1:1201 MAIN ST
Mailing Address - Street 2:STE. 1980
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3299
Mailing Address - Country:US
Mailing Address - Phone:803-748-1256
Mailing Address - Fax:803-754-2900
Practice Address - Street 1:1201 MAIN ST
Practice Address - Street 2:STE. 1980
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3299
Practice Address - Country:US
Practice Address - Phone:803-748-1256
Practice Address - Fax:803-754-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10508207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC105086Medicaid
SC9081Medicare PIN
SC105086Medicaid