Provider Demographics
NPI:1134908981
Name:CARDIO AND VASCULAR IMAGING LLC
Entity type:Organization
Organization Name:CARDIO AND VASCULAR IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLILE
Authorized Official - Suffix:
Authorized Official - Credentials:RDCS, RVS
Authorized Official - Phone:314-398-3975
Mailing Address - Street 1:1746 TIMBER RIDGE ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63011-1976
Mailing Address - Country:US
Mailing Address - Phone:314-398-3975
Mailing Address - Fax:
Practice Address - Street 1:1028 S KIRKWOOD RD
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-7222
Practice Address - Country:US
Practice Address - Phone:314-398-3975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center