Provider Demographics
NPI:1669492427
Name:ADVANCED CARDIOLOGY CONSULTANTS
Entity Type:Organization
Organization Name:ADVANCED CARDIOLOGY CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:HYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-629-8084
Mailing Address - Street 1:1706 2ND LOOP RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-6119
Mailing Address - Country:US
Mailing Address - Phone:843-629-8084
Mailing Address - Fax:843-629-8684
Practice Address - Street 1:1706 2ND LOOP RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-6119
Practice Address - Country:US
Practice Address - Phone:843-629-8084
Practice Address - Fax:843-629-8684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0965Medicaid
SC4633Medicare ID - Type Unspecified