1063482156 NPI number — CARDIOLABS, INC.

Table of content: JUSTIN MICHAEL GRECO MB BCH BAO (NPI 1376032888)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063482156 NPI number — CARDIOLABS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOLABS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063482156
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 S MULBERRY ST STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DICKSON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37055-5023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-304-1098
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 S MULBERRY ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DICKSON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37055-5023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-304-1098
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAAG
Authorized Official First Name:
JEREMY
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL OPERATIONS MANAGER
Authorized Official Telephone Number:
800-304-1098

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 293D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 127935 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7817 . This is a "COVENTRY HEALTHCARE OF KS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 3010968 . This is a "BCBS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 194843 . This is a "ANTHEM BCBS OF VA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: P00093878 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200263800A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3791095 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010157188 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 043260 . This is a "FAMILY HEALTH PARTNERS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 146796 . This is a "UNICARE OF KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 314335 . This is a "HIGHMARK BCBS OF PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 718741408 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 98397 . This is a "OPTIMA SENTARA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 01063104 . This is a "AMERIGROUP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 060A117 . This is a "HEALTHSPRING" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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