Provider Demographics
NPI:1760634398
Name:CARDIOVASCULAR MANAGEMENT INC
Entity Type:Organization
Organization Name:CARDIOVASCULAR MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:CST/SFA
Authorized Official - Phone:918-231-6827
Mailing Address - Street 1:104 GREENTREE DR
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-4113
Mailing Address - Country:US
Mailing Address - Phone:918-231-6827
Mailing Address - Fax:918-207-0006
Practice Address - Street 1:104 GREENTREE DR
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-4113
Practice Address - Country:US
Practice Address - Phone:918-231-6827
Practice Address - Fax:918-207-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty