Provider Demographics
NPI:1881637130
Name:CARDIOVASCULAR ASSOCIATES-THE HEART GROUP MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATES-THE HEART GROUP MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-492-5744
Mailing Address - Street 1:1313 E HERNDON AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3306
Mailing Address - Country:US
Mailing Address - Phone:559-439-6808
Mailing Address - Fax:559-439-9335
Practice Address - Street 1:1313 E HERNDON AVE
Practice Address - Street 2:STE 203
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3306
Practice Address - Country:US
Practice Address - Phone:559-439-6808
Practice Address - Fax:559-439-9335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A228310174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0061010Medicaid
CAGR0061010Medicaid