Provider Demographics
NPI:1205870524
Name:GRANDVIEW CARDIOLOGY, LLC
Entity type:Organization
Organization Name:GRANDVIEW CARDIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-309-2158
Mailing Address - Street 1:980 HIGHWAY 28
Mailing Address - Street 2:SUITE 102
Mailing Address - City:JASPER
Mailing Address - State:TN
Mailing Address - Zip Code:37347-3695
Mailing Address - Country:US
Mailing Address - Phone:423-648-4380
Mailing Address - Fax:
Practice Address - Street 1:980 HIGHWAY 28
Practice Address - Street 2:SUITE 102
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-3695
Practice Address - Country:US
Practice Address - Phone:423-648-4380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3730137Medicaid
TN3730137Medicare ID - Type UnspecifiedCIGNA MEDICARE