Provider Demographics
NPI:1356310007
Name:FOOTHILLS CARDIOTHORACIC, P.A.
Entity Type:Organization
Organization Name:FOOTHILLS CARDIOTHORACIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:HARLAN
Authorized Official - Last Name:PETTIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-583-4420
Mailing Address - Street 1:225 E WOOD ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3050
Mailing Address - Country:US
Mailing Address - Phone:864-583-4420
Mailing Address - Fax:864-542-1045
Practice Address - Street 1:225 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3050
Practice Address - Country:US
Practice Address - Phone:864-583-4420
Practice Address - Fax:864-542-1045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14290208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTL3788Medicaid
NC7905834OtherMEDICAID
SCTL3788Medicaid