Provider Demographics
NPI:1225198914
Name:CARDIAC DIAGNOSITC SERVICES,INC
Entity Type:Organization
Organization Name:CARDIAC DIAGNOSITC SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:CIOCCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-503-5100
Mailing Address - Street 1:4807 ROCKSIDE RD
Mailing Address - Street 2:SUITE 610
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2192
Mailing Address - Country:US
Mailing Address - Phone:216-503-5100
Mailing Address - Fax:216-503-5099
Practice Address - Street 1:4807 ROCKSIDE RD
Practice Address - Street 2:SUITE 610
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2192
Practice Address - Country:US
Practice Address - Phone:216-503-5100
Practice Address - Fax:216-503-5099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2784974Medicaid
OH000000537090OtherANTHEM
OH000000537090OtherANTHEM