Provider Demographics
NPI:1891895090
Name:SOUTH COUNTY CARDIOLOGY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:SOUTH COUNTY CARDIOLOGY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:POISSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-294-5831
Mailing Address - Street 1:426 SCRABBLETOWN RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-3649
Mailing Address - Country:US
Mailing Address - Phone:401-294-5831
Mailing Address - Fax:401-294-7291
Practice Address - Street 1:426 SCRABBLETOWN RD
Practice Address - Street 2:SUITE F
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-3649
Practice Address - Country:US
Practice Address - Phone:401-294-5831
Practice Address - Fax:401-294-7291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
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
RI7001692Medicaid
RI=========OtherTAX ID#