Provider Demographics
NPI:1306845334
Name:CLINICAL CARDIOLOGY SPECIALISTS, INC.
Entity Type:Organization
Organization Name:CLINICAL CARDIOLOGY SPECIALISTS, INC.
Other - Org Name:CLINICAL CARDIOVASCULAR SPECIALISTS, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:TIMKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-459-7676
Mailing Address - Street 1:3525 OLENTANGY RIVER RD
Mailing Address - Street 2:SUITE 6300
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3937
Mailing Address - Country:US
Mailing Address - Phone:614-459-7676
Mailing Address - Fax:614-459-7681
Practice Address - Street 1:3525 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 6300
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3937
Practice Address - Country:US
Practice Address - Phone:614-459-7676
Practice Address - Fax:614-459-7681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-6053207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCM1574OtherRAILROAD MEDICARE
OH0792969Medicaid
OHCM1574OtherRAILROAD MEDICARE