Provider Demographics
NPI:1639695539
Name:CARDINAL MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:CARDINAL MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:B
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-305-5558
Mailing Address - Street 1:515 OGDEN ST STE C
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-1736
Mailing Address - Country:US
Mailing Address - Phone:606-305-5558
Mailing Address - Fax:888-818-6245
Practice Address - Street 1:515 OGDEN ST STE C
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-1736
Practice Address - Country:US
Practice Address - Phone:606-305-5558
Practice Address - Fax:888-818-6245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-22
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies