1609284975 NPI number — CARDINAL INNOVATIVE MEDICAL PRACTICE, P.C.

Table of content: (NPI 1609284975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609284975 NPI number — CARDINAL INNOVATIVE MEDICAL PRACTICE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDINAL INNOVATIVE MEDICAL PRACTICE, P.C.
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:
1609284975
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 CALIFORNIA ST STE 2300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94111-5424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-996-6196
Provider Business Mailing Address Fax Number:
833-523-9924

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 CALIFORNIA ST STE 2300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94111-5424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-996-6196
Provider Business Practice Location Address Fax Number:
833-523-9924
Provider Enumeration Date:
07/30/2014

Additional Information

Authorized Official

Authorized Official Last Name:
THAMES
Authorized Official First Name:
TODD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
800-997-6196

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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