Provider Demographics
NPI:1235171679
Name:CARDIOVASCULAR CLINIC, INC
Entity Type:Organization
Organization Name:CARDIOVASCULAR CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-882-2040
Mailing Address - Street 1:6525 POWERS BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5461
Mailing Address - Country:US
Mailing Address - Phone:440-882-0075
Mailing Address - Fax:440-882-2092
Practice Address - Street 1:6525 POWERS BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5461
Practice Address - Country:US
Practice Address - Phone:440-882-0075
Practice Address - Fax:440-882-2092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0197808Medicaid
OHCA2908OtherRAILROAD MEDICARE GROUP
OHCN3736OtherRAILROAD MEDICARE GROUP #
OHCN3736OtherRAILROAD MEDICARE GROUP #
OH=========OtherMEDICAL MUTUAL GROUP#
OH=========OtherUNITED HEALTH CARE
OH9343431Medicare PIN
OH9913889Medicare PIN
OHCA2908OtherRAILROAD MEDICARE GROUP
OH9913888Medicare PIN