Provider Demographics
NPI:1821295197
Name:CARDIOSOM, LLC
Entity Type:Organization
Organization Name:CARDIOSOM, LLC
Other - Org Name:CARDIOSOM OF SAN LEANDRO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENTCOO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREISL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-706-1080
Mailing Address - Street 1:615 W CARMEL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2996
Mailing Address - Country:US
Mailing Address - Phone:800-868-1920
Mailing Address - Fax:
Practice Address - Street 1:13939 E 14TH ST
Practice Address - Street 2:SUITE190
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2613
Practice Address - Country:US
Practice Address - Phone:510-614-6686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies