Provider Demographics
NPI:1073506325
Name:CARDIOVASCULAR MOBILE SERVICE INC
Entity Type:Organization
Organization Name:CARDIOVASCULAR MOBILE SERVICE INC
Other - Org Name:CMS DIAGNOSTIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:130-522-7250
Mailing Address - Street 1:9200 SW 72ND ST
Mailing Address - Street 2:BUILDING #4
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3240
Mailing Address - Country:US
Mailing Address - Phone:305-227-2500
Mailing Address - Fax:305-220-7133
Practice Address - Street 1:9200 SW 72ND ST BLDG 4
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3240
Practice Address - Country:US
Practice Address - Phone:305-227-2500
Practice Address - Fax:305-403-8740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085R0202X
FLHCC5026261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014102500Medicaid
FL014102500Medicaid