Basic Information
| Provider Information | |||||||||
| NPI: | 1275772378 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARK RIDGE CARDIOLOGY, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 HOSPITAL DR STE 3B | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287925245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286842234 | ||||||||
| FaxNumber: | 8286846693 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 HOSPITAL DR STE 3B | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287925245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286842234 | ||||||||
| FaxNumber: | 8286846693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2009 | ||||||||
| LastUpdateDate: | 02/12/2009 | ||||||||
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| AuthorizedOfficialLastName: | BAILEY | ||||||||
| AuthorizedOfficialFirstName: | ROYCE | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8286842234 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 34D0928163 | NC | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 0227U | 01 | NC | BLUE CROSS NC | OTHER | 890227U | 05 | NC | MEDICAID |