Provider Demographics
NPI:1528091584
Name:CARDIOLOGY CARE OF SC, LLC
Entity type:Organization
Organization Name:CARDIOLOGY CARE OF SC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-932-6875
Mailing Address - Street 1:109 BURTON AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8117
Mailing Address - Country:US
Mailing Address - Phone:843-832-6875
Mailing Address - Fax:843-832-6878
Practice Address - Street 1:109 BURTON AVE
Practice Address - Street 2:SUITE E
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8117
Practice Address - Country:US
Practice Address - Phone:843-832-6875
Practice Address - Fax:843-832-6878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11269207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC112693Medicaid
SCGP4326Medicaid
SC8426Medicare PIN