Basic Information
| Provider Information | |||||||||
| NPI: | 1407893761 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FIRSTHEALTH CARDIODIAGNOSTICS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3000 | ||||||||
| Address2: | |||||||||
| City: | PINEHURST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283743000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107155413 | ||||||||
| FaxNumber: | 9107151926 | ||||||||
| Practice Location | |||||||||
| Address1: | 155 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | PINEHURST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283748710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107155413 | ||||||||
| FaxNumber: | 9107151926 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | VOELPEL | ||||||||
| AuthorizedOfficialFirstName: | STUART | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 9107151000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 5902376 | 05 | NC | MEDICAID |