Provider Demographics
NPI:1083737100
Name:CARDIO VASCULAR IMAGING SERVICES INC
Entity Type:Organization
Organization Name:CARDIO VASCULAR IMAGING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIREY
Authorized Official - Suffix:
Authorized Official - Credentials:RVT RCS BS
Authorized Official - Phone:530-247-1880
Mailing Address - Street 1:PO BOX 492526
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049
Mailing Address - Country:US
Mailing Address - Phone:530-247-1880
Mailing Address - Fax:530-248-3340
Practice Address - Street 1:1850 ROSALINE AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-247-1880
Practice Address - Fax:530-248-3340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ15665ZOtherMEDICARE- UNSPECIFIED