Provider Demographics
NPI:1558476606
Name:STATESVILLE CARDIOVASCULAR CLINIC PA
Entity Type:Organization
Organization Name:STATESVILLE CARDIOVASCULAR CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HEDRICK
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-873-1180
Mailing Address - Street 1:738 BRYANT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-4189
Mailing Address - Country:US
Mailing Address - Phone:704-873-1180
Mailing Address - Fax:704-873-1116
Practice Address - Street 1:738 BRYANT ST
Practice Address - Street 2:SUITE A
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-4189
Practice Address - Country:US
Practice Address - Phone:704-873-1180
Practice Address - Fax:704-873-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0265TOtherBCBS
NCCD2252OtherPALMETTO GBA RR MEDICARE
NC890265TMedicaid
NC250919OtherMAMSI
NC0265TOtherBCBS