Provider Demographics
NPI:1912510603
Name:CARDIAC AND VASCULAR ULTRASOUND
Entity Type:Organization
Organization Name:CARDIAC AND VASCULAR ULTRASOUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:
Authorized Official - Last Name:VANJONACK
Authorized Official - Suffix:
Authorized Official - Credentials:MSS, RCS, RDCS, RVS
Authorized Official - Phone:215-939-0668
Mailing Address - Street 1:2094 FLOWING SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425-2632
Mailing Address - Country:US
Mailing Address - Phone:215-939-0668
Mailing Address - Fax:732-993-7700
Practice Address - Street 1:2094 FLOWING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:CHESTER SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:19425-2632
Practice Address - Country:US
Practice Address - Phone:215-939-0668
Practice Address - Fax:732-993-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA70056OtherULTRASOUND