Provider Demographics
NPI:1386803690
Name:CARDIOLOGY GROUP OF WNY
Entity type:Organization
Organization Name:CARDIOLOGY GROUP OF WNY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER/CPC
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELIA
Authorized Official - Middle Name:W
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:716-634-3502
Mailing Address - Street 1:825 WEHRLE DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7717
Mailing Address - Country:US
Mailing Address - Phone:716-634-3502
Mailing Address - Fax:716-634-1930
Practice Address - Street 1:310 STERLING DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1500
Practice Address - Country:US
Practice Address - Phone:716-677-6800
Practice Address - Fax:716-677-6804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01456019Medicaid
NY01456019Medicaid