Provider Demographics
NPI:1609042555
Name:CARDIOVASCULAR AND MEDICAL SPECIALISTS LABORATORY
Entity Type:Organization
Organization Name:CARDIOVASCULAR AND MEDICAL SPECIALISTS LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASBIR
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:MAKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-723-5500
Mailing Address - Street 1:485 COLLIERS WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5012
Mailing Address - Country:US
Mailing Address - Phone:304-723-5500
Mailing Address - Fax:304-723-5516
Practice Address - Street 1:485 COLLIERS WAY
Practice Address - Street 2:SUITE A
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5012
Practice Address - Country:US
Practice Address - Phone:304-723-5500
Practice Address - Fax:304-723-5516
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARDIOVASCULAR AND MEDICAL SPECIALISTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV51D0235841291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0040293000Medicaid