Provider Demographics
NPI:1841235231
Name:CARDIO-MEDICAL AFFILIATES
Entity Type:Organization
Organization Name:CARDIO-MEDICAL AFFILIATES
Other - Org Name:DBA CAROLINA MEDICAL AFFILIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-585-5433
Mailing Address - Street 1:PO BOX 2288
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-2288
Mailing Address - Country:US
Mailing Address - Phone:864-585-5433
Mailing Address - Fax:864-591-4053
Practice Address - Street 1:1330 BOILING SPRINGS RD
Practice Address - Street 2:SUITE 2500
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2244
Practice Address - Country:US
Practice Address - Phone:864-585-5433
Practice Address - Fax:864-591-4053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19036207KA0200X
SC207R00000X
SC26760207RI0011X
SCTL27557207RI0011X
SC27614207RI0011X
SC14717207RI0200X
SC23983207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0077Medicaid
SC1562Medicare PIN