Provider Demographics
NPI:1821112673
Name:BRUNSWICK CARDIOLOGY
Entity type:Organization
Organization Name:BRUNSWICK CARDIOLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-755-7192
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-0427
Mailing Address - Country:US
Mailing Address - Phone:910-755-7192
Mailing Address - Fax:910-755-7194
Practice Address - Street 1:20 MEDICAL CAMPUS DR NW STE 203
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4094
Practice Address - Country:US
Practice Address - Phone:910-755-7192
Practice Address - Fax:910-755-7194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35196174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8975177Medicaid
NC561776208BOtherCIGNA HEALTHCARE
NC75177OtherBLUE CROSS BLUE SHIELD
NC2207970OtherUNITED HEALTHCARE
NC=========BOtherCIGNA HEALTHCARE
NC234773Medicare PIN
NC75177OtherBLUE CROSS BLUE SHIELD