Provider Demographics
NPI:1518693605
Name:CCA INTERMEDIATE HOLDINGS, PC
Entity Type:Organization
Organization Name:CCA INTERMEDIATE HOLDINGS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-324-5135
Mailing Address - Street 1:196 CARDIOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1174
Mailing Address - Country:US
Mailing Address - Phone:803-324-5135
Mailing Address - Fax:803-324-5269
Practice Address - Street 1:196 CARDIOLOGY DR
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1174
Practice Address - Country:US
Practice Address - Phone:803-324-5135
Practice Address - Fax:803-324-5269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty