Provider Demographics
NPI:1720782105
Name:CARDIAC DIAGNOSTIC MONITORING SYSTEMS
Entity Type:Organization
Organization Name:CARDIAC DIAGNOSTIC MONITORING SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:FRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-427-1777
Mailing Address - Street 1:881 W STATE RD # 140-101
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-2131
Mailing Address - Country:US
Mailing Address - Phone:801-427-1777
Mailing Address - Fax:833-726-3279
Practice Address - Street 1:3140 DE LA CRUZ BLVD
Practice Address - Street 2:200
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-2444
Practice Address - Country:US
Practice Address - Phone:801-427-1777
Practice Address - Fax:833-726-3279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory