Basic Information
| Provider Information | |||||||||
| NPI: | 1346604873 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SJC ELECTROPHYSIOLOGY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 602 E 72ND ST | ||||||||
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| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314054913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123033560 | ||||||||
| FaxNumber: | 9123033506 | ||||||||
| Practice Location | |||||||||
| Address1: | 1326 EISENHOWER DR | ||||||||
| Address2: | BLDG 2 | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314063928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125275300 | ||||||||
| FaxNumber: | 9125275154 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2016 | ||||||||
| LastUpdateDate: | 04/11/2016 | ||||||||
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| AuthorizedOfficialLastName: | HINCHEY | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/ CEO | ||||||||
| AuthorizedOfficialTelephone: | 9128196901 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ST. JOSEPH'S HOSPITAL, INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | 070682 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
No ID Information.