Provider Demographics
NPI:1780220525
Name:ELK GROVE CARDIOLOGY INC
Entity Type:Organization
Organization Name:ELK GROVE CARDIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRYSTEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-622-7312
Mailing Address - Street 1:8120 TIMBERLAKE WAY STE 210B
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-5414
Mailing Address - Country:US
Mailing Address - Phone:916-251-3058
Mailing Address - Fax:916-282-2441
Practice Address - Street 1:8120 TIMBERLAKE WAY STE 210B
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5414
Practice Address - Country:US
Practice Address - Phone:916-251-3058
Practice Address - Fax:916-282-2441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-26
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty