MEDICARE: CARDIOSOM, LLC

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	332BX2000X	Oxygen Equipment & Supplies (DME)

General Provider Information

NPI Number	:	1316108558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOSOM, LLC

Provider Business Mailing Address
First Line	:	615 W CARMEL DR
Second Line	:	SUITE 100
City	:	CARMEL
State	:	IN
Zip	:	46032-2996
Country	:	US
Telephone Number	:	800-868-1920
Fax Number	:	800-868-1908

Provider Business Practice Location Address
First Line	:	4109 STUART ANDREW BLVD
Second Line	:	SUITE J
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-4621
Country	:	US
Telephone Number	:	800-868-1920
Fax Number	:	800-868-1908

Authorized Official
Title or Position	:	PRESIDENT COO
Name	:	KEVIN GREISL
Credential	:
Telephone Number	:	800-868-1920

Provider Enumeration Date	:	06/20/2008
Last Update Date	:	09/15/2009

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