1194913293 NPI number — CLINICAL CARDIOLOGY SPECIALISTS, INC

Table of content: (NPI 1194913293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194913293 NPI number — CLINICAL CARDIOLOGY SPECIALISTS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICAL CARDIOLOGY SPECIALISTS, 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:
6
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:
1194913293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
551 W CENTRAL AVE
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
DELAWARE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43015-1493
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-368-5077
Provider Business Mailing Address Fax Number:
740-368-5041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
551 W CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
DELAWARE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43015-1493
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-368-5077
Provider Business Practice Location Address Fax Number:
740-368-5041
Provider Enumeration Date:
10/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COLLIER-CRESPIN
Authorized Official First Name:
ANGIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATON
Authorized Official Telephone Number:
614-459-7676

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2330801 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: CM1574 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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