1437194750 NPI number — CARDIOVASCULAR CONSULTANTS MEDICAL GROUP, INC.

Table of content: (NPI 1437194750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437194750 NPI number — CARDIOVASCULAR CONSULTANTS MEDICAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOVASCULAR CONSULTANTS MEDICAL GROUP, 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:
1437194750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2855 MITCHELL DR
Provider Second Line Business Mailing Address:
#223
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94598-1600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-516-3230
Provider Business Mailing Address Fax Number:
925-516-3235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 BALFOUR RD
Provider Second Line Business Practice Location Address:
#215
Provider Business Practice Location Address City Name:
BRENTWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94513-4945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-516-3230
Provider Business Practice Location Address Fax Number:
925-516-3235
Provider Enumeration Date:
06/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LUDMER
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
510-452-1345

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: ZZZ66011Z . This is a "BLUE SHIELD PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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