Provider Demographics
NPI:1659674125
Name:CARDIOVASCULAR ASSESSMENT & DIAGNOSTIC SERVICES, L.L.C.
Entity Type:Organization
Organization Name:CARDIOVASCULAR ASSESSMENT & DIAGNOSTIC SERVICES, L.L.C.
Other - Org Name:BUCKEYE VEIN CARE SPECIALIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUNCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-563-2183
Mailing Address - Street 1:229 S CHILLICOTHE ST
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-1240
Mailing Address - Country:US
Mailing Address - Phone:614-563-2183
Mailing Address - Fax:
Practice Address - Street 1:6810 PERIMETER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-8047
Practice Address - Country:US
Practice Address - Phone:614-563-2183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARDIOVASCULAR ASSESSMENT & DIAGNOSTIC SERVICES, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty