Provider Demographics
NPI:1346503174
Name:CARDIOVASCULAR IMAGING
Entity Type:Organization
Organization Name:CARDIOVASCULAR IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:APN, RN
Authorized Official - Phone:423-870-1999
Mailing Address - Street 1:1017 EXECUTIVE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-7910
Mailing Address - Country:US
Mailing Address - Phone:423-870-1999
Mailing Address - Fax:423-870-1977
Practice Address - Street 1:1017 EXECUTIVE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-7910
Practice Address - Country:US
Practice Address - Phone:423-870-1999
Practice Address - Fax:423-870-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center