Provider Demographics
NPI:1841220928
Name:CARDIOPULMONARY SERVICES, INC
Entity Type:Organization
Organization Name:CARDIOPULMONARY SERVICES, INC
Other - Org Name:CPS MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:FLY
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-592-7851
Mailing Address - Street 1:2913 TEAGUE DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-3753
Mailing Address - Country:US
Mailing Address - Phone:903-592-7851
Mailing Address - Fax:903-597-6927
Practice Address - Street 1:2913 TEAGUE DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-3753
Practice Address - Country:US
Practice Address - Phone:903-592-7851
Practice Address - Fax:903-597-6927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0035717332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0414540001Medicare ID - Type Unspecified