Provider Demographics
NPI:1497378855
Name:CHAMPION HEART AND VASCULAR CENTER, OXFORD PLLC
Entity Type:Organization
Organization Name:CHAMPION HEART AND VASCULAR CENTER, OXFORD PLLC
Other - Org Name:CHAMPION URGENT AND PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RADHAKRISHNAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMARAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-304-1212
Mailing Address - Street 1:1614 WILLIAMSBORO STREET
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565
Mailing Address - Country:US
Mailing Address - Phone:919-339-4077
Mailing Address - Fax:855-618-2311
Practice Address - Street 1:1614 WILLIAMSBORO ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-5016
Practice Address - Country:US
Practice Address - Phone:919-339-4077
Practice Address - Fax:855-618-2311
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHAMPION HEART & VASCULAR CENTER, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-20
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1497378855Medicaid