Provider Demographics
NPI:1952305476
Name:CARDIOVASCULAR IMAGING SERVICES, INC.
Entity Type:Organization
Organization Name:CARDIOVASCULAR IMAGING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:DELAPA
Authorized Official - Suffix:
Authorized Official - Credentials:BA, RVT, RT
Authorized Official - Phone:740-894-7155
Mailing Address - Street 1:189 COUNTY ROAD 276
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680-8912
Mailing Address - Country:US
Mailing Address - Phone:740-894-7155
Mailing Address - Fax:740-894-3390
Practice Address - Street 1:189 COUNTY ROAD 276
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680-8912
Practice Address - Country:US
Practice Address - Phone:740-894-7155
Practice Address - Fax:740-894-3390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085R0202X
OH1289432335V00000X
WV056667335V00000X
KY720255335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6801014-000Medicaid
KY86000403Medicaid
OH2273712Medicaid
WVID01551Medicare PIN
OHX60387Medicare UPIN
OH2273712Medicaid
KY9373001Medicare PIN