Provider Demographics
NPI:1598031379
Name:CARDIOVASCULAR SUPPORT SERVICES
Entity Type:Organization
Organization Name:CARDIOVASCULAR SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERFUSIONIST
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-824-2510
Mailing Address - Street 1:621 N HALL ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75226-1339
Mailing Address - Country:US
Mailing Address - Phone:214-824-2510
Mailing Address - Fax:214-826-0130
Practice Address - Street 1:865 DESHONG DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-9313
Practice Address - Country:US
Practice Address - Phone:903-785-4521
Practice Address - Fax:903-737-3848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPF1153242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionistGroup - Single Specialty