Provider Demographics
NPI:1548205602
Name:REGIONAL CARDIOLOGY CONSULTANTS, PC
Entity Type:Organization
Organization Name:REGIONAL CARDIOLOGY CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WOODIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEMING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-664-4446
Mailing Address - Street 1:130 STONEBRIDGE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2086
Mailing Address - Country:US
Mailing Address - Phone:731-664-4446
Mailing Address - Fax:731-664-7829
Practice Address - Street 1:130 STONEBRIDGE BLVD STE A
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2086
Practice Address - Country:US
Practice Address - Phone:731-664-4446
Practice Address - Fax:731-664-7829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3703306Medicaid
TN3703306Medicare ID - Type Unspecified