Provider Demographics
NPI:1992837249
Name:COMPREHENSIVE CARDIOLOGY CONSULTANTS, INC
Entity Type:Organization
Organization Name:COMPREHENSIVE CARDIOLOGY CONSULTANTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WIETMARSCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:513-871-5700
Mailing Address - Street 1:311 STRAIGHT ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1018
Mailing Address - Country:US
Mailing Address - Phone:513-861-5555
Mailing Address - Fax:513-861-0999
Practice Address - Street 1:10496 MONTGOMERY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-5223
Practice Address - Country:US
Practice Address - Phone:513-791-2055
Practice Address - Fax:513-791-6314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0262193Medicaid
OH0262193Medicaid