Provider Demographics
NPI:1275670309
Name:CARDIODIAGNOSTIC SERVICES
Entity Type:Organization
Organization Name:CARDIODIAGNOSTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-901-4101
Mailing Address - Street 1:PO BOX 1706
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43086-1706
Mailing Address - Country:US
Mailing Address - Phone:614-901-4101
Mailing Address - Fax:614-890-7803
Practice Address - Street 1:110 POLARIS PKWY
Practice Address - Street 2:SUITE 230
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8024
Practice Address - Country:US
Practice Address - Phone:614-901-4101
Practice Address - Fax:614-890-7807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCAID02261Medicare UPIN