Provider Demographics
NPI:1356845945
Name:CENTRIC HEART & VASCULAR LLC
Entity Type:Organization
Organization Name:CENTRIC HEART & VASCULAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJEEV
Authorized Official - Middle Name:DHARI
Authorized Official - Last Name:RAVIPUDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-394-6299
Mailing Address - Street 1:2103 SILVA LN
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-3660
Mailing Address - Country:US
Mailing Address - Phone:660-616-0022
Mailing Address - Fax:
Practice Address - Street 1:2103 SILVA LN
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-3660
Practice Address - Country:US
Practice Address - Phone:660-616-0022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002015751207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty