Provider Demographics
NPI:1457591737
Name:SELECT CV IMAGING, LLC
Entity type:Organization
Organization Name:SELECT CV IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHIBU
Authorized Official - Middle Name:MATHEW
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:972-468-8155
Mailing Address - Street 1:614 GREEN APPLE DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-2562
Mailing Address - Country:US
Mailing Address - Phone:972-468-8155
Mailing Address - Fax:801-807-1556
Practice Address - Street 1:614 GREEN APPLE DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-2562
Practice Address - Country:US
Practice Address - Phone:972-468-8155
Practice Address - Fax:801-807-1556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2009-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FTC014Medicare PIN