1750486924 NPI number — CARDIODIAGNOSTICS OF COLORADO SPRINGS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750486924 NPI number — CARDIODIAGNOSTICS OF COLORADO SPRINGS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIODIAGNOSTICS OF COLORADO SPRINGS, 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:
1750486924
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5225 N ACADEMY BLVD
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80918-4000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-444-3777
Provider Business Mailing Address Fax Number:
719-444-3756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5225 N ACADEMY BLVD
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80918-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-444-3777
Provider Business Practice Location Address Fax Number:
719-444-3756
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEARDSLEE
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
719-623-2201

Provider Taxonomy Codes

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

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

  • Identifier: 30153 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 04301537 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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