Provider Demographics
NPI:1710377064
Name:CARDIOVASCULAR CAPITAL
Entity Type:Organization
Organization Name:CARDIOVASCULAR CAPITAL
Other - Org Name:CARDIOVASCULAR CAPITAL, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:S
Authorized Official - Last Name:COHLMIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-456-9500
Mailing Address - Street 1:1373 E BOONE ST STE 3400
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-3365
Mailing Address - Country:US
Mailing Address - Phone:918-456-9500
Mailing Address - Fax:
Practice Address - Street 1:1373 E BOONE ST STE 3400
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-3365
Practice Address - Country:US
Practice Address - Phone:918-456-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15023174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty