Provider Demographics
NPI:1164452645
Name:SOUTHWEST CARDIOLOGY INC
Entity Type:Organization
Organization Name:SOUTHWEST CARDIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:STULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-293-3486
Mailing Address - Street 1:3533 SOUTHERN BLVD
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1267
Mailing Address - Country:US
Mailing Address - Phone:937-293-3486
Mailing Address - Fax:
Practice Address - Street 1:3533 SOUTHERN BLVD
Practice Address - Street 2:SUITE 2100
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1267
Practice Address - Country:US
Practice Address - Phone:937-293-3486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1540749OtherTHE FUNDS UMW
OH2116552Medicaid
OH020191600OtherBLACK LUNG
OH2153763OtherAETNA
OH060053779OtherRR MEDICARE
OH060053779OtherRR MEDICARE
OH2116552Medicaid