Provider Demographics
NPI:1053337626
Name:CARDIOLOGY ASSOCIATES OF CHARLESTON LLC
Entity type:Organization
Organization Name:CARDIOLOGY ASSOCIATES OF CHARLESTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-571-2939
Mailing Address - Street 1:615 WESLEY DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7204
Mailing Address - Country:US
Mailing Address - Phone:843-571-2939
Mailing Address - Fax:843-571-4686
Practice Address - Street 1:615 WESLEY DR
Practice Address - Street 2:SUITE 320
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7204
Practice Address - Country:US
Practice Address - Phone:843-571-2939
Practice Address - Fax:843-571-4686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0453Medicaid
SC7181OtherMEDICARE-PTAN
SCGP0453Medicaid
SCD17884Medicare UPIN
SCF62095Medicare UPIN