Provider Demographics
NPI:1215556089
Name:HEART2HEART CONCIERGE CARDIOVASCULAR DIAGNOSTIC SERVICES LLC
Entity Type:Organization
Organization Name:HEART2HEART CONCIERGE CARDIOVASCULAR DIAGNOSTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARDIOVASCULAR SONOGRAPHER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ANTWAUN
Authorized Official - Last Name:ACCILIEN
Authorized Official - Suffix:
Authorized Official - Credentials:RCS-CCT# 00068873
Authorized Official - Phone:540-441-4259
Mailing Address - Street 1:PO BOX 1678
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-0036
Mailing Address - Country:US
Mailing Address - Phone:540-441-4259
Mailing Address - Fax:
Practice Address - Street 1:120 E 3RD ST APT 1678
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-4434
Practice Address - Country:US
Practice Address - Phone:540-441-4259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-13
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty