MEDICARE: CARDIOVASCULAR IMAGING, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1073586202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOVASCULAR IMAGING, INC.

Provider Business Mailing Address
First Line	:	64040 HIGHWAY 434
Second Line	:	SUITE 200
City	:	LACOMBE
State	:	LA
Zip	:	70445-3456
Country	:	US
Telephone Number	:	985-892-9233
Fax Number	:	985-871-9345

Provider Business Practice Location Address
First Line	:	64040 HIGHWAY 434
Second Line	:	SUITE 200
City	:	LACOMBE
State	:	LA
Zip	:	70445-3456
Country	:	US
Telephone Number	:	985-892-9233
Fax Number	:	985-871-9345

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES EMERSON SMITH III
Credential	:	M.D.
Telephone Number	:	985-892-9233

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	08/22/2020

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