Provider Demographics
NPI:1275772378
Name:PARK RIDGE CARDIOLOGY, PLLC
Entity Type:Organization
Organization Name:PARK RIDGE CARDIOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROYCE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-684-2234
Mailing Address - Street 1:50 HOSPITAL DR STE 3B
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-5245
Mailing Address - Country:US
Mailing Address - Phone:828-684-2234
Mailing Address - Fax:828-684-6693
Practice Address - Street 1:50 HOSPITAL DR STE 3B
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-5245
Practice Address - Country:US
Practice Address - Phone:828-684-2234
Practice Address - Fax:828-684-6693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34D0928163291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0227UOtherBLUE CROSS NC
NC890227UMedicaid
NC2323402Medicare PIN
NC1003893892Medicare NSC