Provider Demographics
NPI:1841283173
Name:UPSTATE CARDIOLOGY PA
Entity type:Organization
Organization Name:UPSTATE CARDIOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CEBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-235-7665
Mailing Address - Street 1:2 INNOVATION DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5261
Mailing Address - Country:US
Mailing Address - Phone:864-835-7665
Mailing Address - Fax:864-233-5971
Practice Address - Street 1:2 INNOVATION DR
Practice Address - Street 2:SUITE 400
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5261
Practice Address - Country:US
Practice Address - Phone:864-835-7665
Practice Address - Fax:864-233-5971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0975Medicaid
SC8157Medicare PIN
SC4695Medicare ID - Type Unspecified