Provider Demographics
NPI:1477585495
Name:CARDIOLOGY CARE INC
Entity Type:Organization
Organization Name:CARDIOLOGY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:CZAJKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-335-3518
Mailing Address - Street 1:3006 N COUNTY ROAD 25A
Mailing Address - Street 2:STE 104
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1373
Mailing Address - Country:US
Mailing Address - Phone:937-335-3518
Mailing Address - Fax:937-335-1231
Practice Address - Street 1:3006 N COUNTY ROAD 25A
Practice Address - Street 2:STE 104
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1373
Practice Address - Country:US
Practice Address - Phone:937-335-3518
Practice Address - Fax:937-335-1231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH021213700OtherBLACK LUNG
OH000000010016OtherANTHEM PIN
OH5315621OtherAETNA
OH0885412Medicaid
OH=========OtherEIN
OH0885412Medicaid