Provider Demographics
NPI:1881758845
Name:CITY CARDIOLOGY ASSOCIATES
Entity type:Organization
Organization Name:CITY CARDIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPANY MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTI
Authorized Official - Middle Name:A
Authorized Official - Last Name:HYSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-753-6699
Mailing Address - Street 1:201 5TH ST NE STE 18
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-3017
Mailing Address - Country:US
Mailing Address - Phone:330-753-6699
Mailing Address - Fax:330-753-8559
Practice Address - Street 1:201 5TH ST NE STE 18
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-3017
Practice Address - Country:US
Practice Address - Phone:330-753-6699
Practice Address - Fax:330-753-8559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9306131OtherMEDICARE PTAN
OH9306133Medicare ID - Type UnspecifiedSTOW
OH9306131OtherMEDICARE PTAN
OH9306132Medicare ID - Type UnspecifiedAKRON