Provider Demographics
NPI:1801040472
Name:ON-SITE CARDIAC IMAGING CORP
Entity Type:Organization
Organization Name:ON-SITE CARDIAC IMAGING CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-252-8364
Mailing Address - Street 1:3380 FAIRLANE FARMS RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8764
Mailing Address - Country:US
Mailing Address - Phone:561-252-8364
Mailing Address - Fax:561-333-6671
Practice Address - Street 1:3380 FAIRLANE FARMS RD
Practice Address - Street 2:SUITE 6
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8764
Practice Address - Country:US
Practice Address - Phone:561-252-8364
Practice Address - Fax:561-333-6671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8298261QR0208X, 261QR0404X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No261QR0404XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Cardiac Facilities