Provider Demographics
NPI:1194854547
Name:CARDIO SCAN INC
Entity Type:Organization
Organization Name:CARDIO SCAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RDCS
Authorized Official - Phone:210-710-5742
Mailing Address - Street 1:8026 VANTAGE DR STE 224
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4728
Mailing Address - Country:US
Mailing Address - Phone:210-979-0563
Mailing Address - Fax:
Practice Address - Street 1:8026 VANTAGE DR STE 224
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4728
Practice Address - Country:US
Practice Address - Phone:210-979-0563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164309001Medicaid
TX164309001Medicaid