Provider Demographics
NPI:1770583288
Name:CARDIOPULMONARY CARE INC
Entity type:Organization
Organization Name:CARDIOPULMONARY CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:GOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-385-6177
Mailing Address - Street 1:PO BOX 997
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-0997
Mailing Address - Country:US
Mailing Address - Phone:740-385-6177
Mailing Address - Fax:740-385-0474
Practice Address - Street 1:140 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-1328
Practice Address - Country:US
Practice Address - Phone:740-385-6177
Practice Address - Fax:740-385-0474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0333740Medicaid
400059OtherDEPT OF LABOR
400059OtherDEPT OF LABOR