Provider Demographics
NPI:1447580246
Name:CARDIOSONIC IMAGING CORP.
Entity Type:Organization
Organization Name:CARDIOSONIC IMAGING CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARDIOVASCULAR SONOGRAPHER
Authorized Official - Prefix:MR
Authorized Official - First Name:OMID
Authorized Official - Middle Name:
Authorized Official - Last Name:TAHMOURPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:RCS
Authorized Official - Phone:727-505-4884
Mailing Address - Street 1:P.O. BOX 10271
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34603
Mailing Address - Country:US
Mailing Address - Phone:727-505-4884
Mailing Address - Fax:352-610-4800
Practice Address - Street 1:7614 JACQUE ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667
Practice Address - Country:US
Practice Address - Phone:727-505-4884
Practice Address - Fax:352-610-4800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00068977246W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, CardiologyGroup - Single Specialty