Provider Demographics
NPI:1043433246
Name:CACHE VALLEY CARDIOLOGY PC
Entity Type:Organization
Organization Name:CACHE VALLEY CARDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-755-8200
Mailing Address - Street 1:1300 N 500 E
Mailing Address - Street 2:SUITE 320
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2408
Mailing Address - Country:US
Mailing Address - Phone:435-755-8200
Mailing Address - Fax:435-752-6094
Practice Address - Street 1:1300 N 500 E
Practice Address - Street 2:SUITE 320
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2408
Practice Address - Country:US
Practice Address - Phone:435-755-8200
Practice Address - Fax:435-752-6094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty