Provider Demographics
NPI:1073737136
Name:CARDIOVASCULAR SPECIALISTS, LLC
Entity Type:Organization
Organization Name:CARDIOVASCULAR SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-653-7511
Mailing Address - Street 1:618 PLEASANTVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3312
Mailing Address - Country:US
Mailing Address - Phone:740-653-7511
Mailing Address - Fax:740-653-7512
Practice Address - Street 1:6441 WINCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-2033
Practice Address - Country:US
Practice Address - Phone:740-653-7511
Practice Address - Fax:740-689-9236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9383041Medicare PIN