1063482156 NPI number — CARDIOLABS, INC.

Table of content: (NPI 1083317168)

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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