Provider Demographics
NPI:1114937893
Name:CARDIOSOM, LLC
Entity Type:Organization
Organization Name:CARDIOSOM, LLC
Other - Org Name:CARDIOSOM OF NOBLESVILLE
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:317-706-1080
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:46032-5504
Mailing Address - Country:US
Mailing Address - Phone:317-706-1080
Mailing Address - Fax:317-574-8674
Practice Address - Street 1:17527 RIVER ROAD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-8528
Practice Address - Country:US
Practice Address - Phone:317-219-3360
Practice Address - Fax:317-219-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN69000012A332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200835690AMedicaid
IN200835690AMedicaid