Provider Demographics
NPI:1619216058
Name:ST. JOSEPH'S CARDIOLOGY GROUP, LLC
Entity Type:Organization
Organization Name:ST. JOSEPH'S CARDIOLOGY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:P
Authorized Official - Last Name:HINCHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-819-6901
Mailing Address - Street 1:836 E. 65TH STREET
Mailing Address - Street 2:SUITE 20
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:912-819-7878
Mailing Address - Fax:912-819-5044
Practice Address - Street 1:11700 MERCY BLVD.
Practice Address - Street 2:PLAZA D #6
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419
Practice Address - Country:US
Practice Address - Phone:912-927-3434
Practice Address - Fax:912-927-5016
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. JOSEPH'S CARDIOLOGY GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-05
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003162061AMedicaid
GA202G700404Medicare PIN
GA202G700404Medicare PIN