Provider Demographics
NPI:1508364886
Name:CARDIAC CIN OF CHARLOTTE LLC
Entity Type:Organization
Organization Name:CARDIAC CIN OF CHARLOTTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LELAND HUTTON
Authorized Official - Last Name:EADIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-733-2064
Mailing Address - Street 1:102 WOODMONT BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2216
Mailing Address - Country:US
Mailing Address - Phone:615-386-0064
Mailing Address - Fax:615-386-0067
Practice Address - Street 1:15720 BRIXHAM HILL AVE STE 300C
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4784
Practice Address - Country:US
Practice Address - Phone:615-386-0064
Practice Address - Fax:615-386-0067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-31
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty