Provider Demographics
NPI:1639618937
Name:CARDIOMED IMAGING LLC
Entity Type:Organization
Organization Name:CARDIOMED IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-303-3911
Mailing Address - Street 1:1016 MANN ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4121
Mailing Address - Country:US
Mailing Address - Phone:908-303-3911
Mailing Address - Fax:561-392-3793
Practice Address - Street 1:1016 MANN ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4121
Practice Address - Country:US
Practice Address - Phone:908-303-3911
Practice Address - Fax:561-392-3793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL15000171138302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL15000171138OtherDOCUMENT NUMBER