Provider Demographics
NPI:1477548790
Name:CARDIOVASULAR PHYSICIANS/MERCY HEALTH PARTNERS,LLC
Entity Type:Organization
Organization Name:CARDIOVASULAR PHYSICIANS/MERCY HEALTH PARTNERS,LLC
Other - Org Name:CARDIOVASCULAR DIAGNOSTIC INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:RCIS
Authorized Official - Phone:419-251-4169
Mailing Address - Street 1:2409 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2625
Mailing Address - Country:US
Mailing Address - Phone:419-251-4169
Mailing Address - Fax:419-251-3776
Practice Address - Street 1:2409 CHERRY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2625
Practice Address - Country:US
Practice Address - Phone:419-251-4169
Practice Address - Fax:419-251-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2295145Medicaid
OH2295145Medicaid