Provider Demographics
NPI:1881875193
Name:COMPREHENSIVE CARDIOLOGY CONS INC
Entity type:Organization
Organization Name:COMPREHENSIVE CARDIOLOGY CONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:WIETMARSCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-872-5700
Mailing Address - Street 1:PO BOX 691635
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45269-1635
Mailing Address - Country:US
Mailing Address - Phone:513-872-5700
Mailing Address - Fax:513-861-6980
Practice Address - Street 1:415 STRAIGHT ST
Practice Address - Street 2:SUITE 210
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1060
Practice Address - Country:US
Practice Address - Phone:513-872-5700
Practice Address - Fax:513-861-6980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3692OtherMEDICARE
CC6066OtherRAILROAD MEDICARE
OH0262193Medicaid
KY00342OtherMEDICARE
KY3690OtherMEDICARE
KY5348OtherMEDICARE
KY65940835Medicaid
CC6065OtherRAILROAD MEDICARE
KY5626Medicare PIN
KY3690OtherMEDICARE
KY65940835Medicaid
OH9285682Medicare PIN
OH9355201Medicare PIN
OH9285681Medicare PIN