Basic Information
| Provider Information | |||||||||
| NPI: | 1316239346 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY CARDIOLOGY ASSOCIATES LLC | ||||||||
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| OtherOrganizationName: | AUGUSTA CARDIOLOGY CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 820 SAINT SEBASTIAN WAY STE 7A | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309012641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067747263 | ||||||||
| FaxNumber: | 7067747230 | ||||||||
| Practice Location | |||||||||
| Address1: | 818 SAINT SEBASTIAN WAY STE 311 | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309012653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067243473 | ||||||||
| FaxNumber: | 7067227307 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2011 | ||||||||
| LastUpdateDate: | 04/15/2013 | ||||||||
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| AuthorizedOfficialLastName: | BELKOSKI | ||||||||
| AuthorizedOfficialFirstName: | DAVE | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE VP/CFO | ||||||||
| AuthorizedOfficialTelephone: | 7067243473 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 208G00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 207RC0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.