Provider Demographics
NPI:1750388070
Name:CARDIO STAT INC
Entity type:Organization
Organization Name:CARDIO STAT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JEFFCOAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-957-0500
Mailing Address - Street 1:PO BOX 1928
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29071-1928
Mailing Address - Country:US
Mailing Address - Phone:803-957-0500
Mailing Address - Fax:803-358-1736
Practice Address - Street 1:171A MONROE LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3904
Practice Address - Country:US
Practice Address - Phone:803-358-6715
Practice Address - Fax:803-358-1715
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL SERVICES OF AMERICA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPL0006Medicaid
SCPL0006Medicaid