Provider Demographics
NPI:1003077231
Name:CARDIOSOM, LLC
Entity Type:Organization
Organization Name:CARDIOSOM, LLC
Other - Org Name:CARDIOSOM OF ORLANDO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:JARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-868-1920
Mailing Address - Street 1:615 W CARMEL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2996
Mailing Address - Country:US
Mailing Address - Phone:800-868-1920
Mailing Address - Fax:800-868-1908
Practice Address - Street 1:2151 CONSULATE DR
Practice Address - Street 2:UNIT 20
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-8807
Practice Address - Country:US
Practice Address - Phone:407-850-0367
Practice Address - Fax:407-856-6152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5348030030Medicare NSC