Provider Demographics
NPI:1790740447
Name:MMH-COR ENTERPRISES IV LLC
Entity Type:Organization
Organization Name:MMH-COR ENTERPRISES IV LLC
Other - Org Name:CARDIOVASCULAR DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-274-6000
Mailing Address - Street 1:5 VANDERBILT PARK DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1700
Mailing Address - Country:US
Mailing Address - Phone:828-274-6000
Mailing Address - Fax:828-277-6350
Practice Address - Street 1:5 VANDERBILT PARK DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1700
Practice Address - Country:US
Practice Address - Phone:828-274-6000
Practice Address - Fax:828-277-6350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38785174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC470001688Medicaid
NC2881739Medicare ID - Type Unspecified