Provider Demographics
NPI:1477970010
Name:INTERNAL MEDICINE AND CARDIOLOGY
Entity Type:Organization
Organization Name:INTERNAL MEDICINE AND CARDIOLOGY
Other - Org Name:PEACE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VINITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SRIVASTAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-233-2744
Mailing Address - Street 1:401 GUESS ST
Mailing Address - Street 2:STE 100
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4155
Mailing Address - Country:US
Mailing Address - Phone:864-233-2744
Mailing Address - Fax:864-331-2896
Practice Address - Street 1:401 GUESS ST
Practice Address - Street 2:STE 100
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4155
Practice Address - Country:US
Practice Address - Phone:864-233-2744
Practice Address - Fax:864-331-2896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18695364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontologyGroup - Single Specialty