Provider Demographics
NPI:1740231935
Name:LOWCOUNTRY CARDIOLOGY ASSOCIATES, PA
Entity Type:Organization
Organization Name:LOWCOUNTRY CARDIOLOGY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:H
Authorized Official - Last Name:HANGER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD FAAC
Authorized Official - Phone:843-853-0250
Mailing Address - Street 1:4969 CENTRE POINTE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-6952
Mailing Address - Country:US
Mailing Address - Phone:843-853-0250
Mailing Address - Fax:843-723-4566
Practice Address - Street 1:4969 CENTRE POINTE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-6952
Practice Address - Country:US
Practice Address - Phone:843-853-0250
Practice Address - Fax:843-723-4566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207RC0000X, 363AM0700X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4251OtherMEDICARE GROUP #
SCGP0624Medicaid