Provider Demographics
NPI:1376700567
Name:CARDIOVASCULAR CONSULTANTS, INC.
Entity Type:Organization
Organization Name:CARDIOVASCULAR CONSULTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANFULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-454-8076
Mailing Address - Street 1:2600 6TH ST SW
Mailing Address - Street 2:SUITE A2-710
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-1702
Mailing Address - Country:US
Mailing Address - Phone:330-454-8076
Mailing Address - Fax:330-454-3927
Practice Address - Street 1:2021 WALES RD NE
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-4186
Practice Address - Country:US
Practice Address - Phone:330-454-8076
Practice Address - Fax:330-454-3927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCA9290596Medicare PIN