MEDICARE: CARDIOVASCULAR MOBILE ULTRASOUND 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	261QR0208X	Mobile Radiology Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	U3741	OTHER		MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V2964	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821285388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOVASCULAR MOBILE ULTRASOUND INC

Provider Business Mailing Address
First Line	:	13904 GLOVER PLACE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-3126
Country	:	US
Telephone Number	:	813-417-5888
Fax Number	:	813-962-8350

Provider Business Practice Location Address
First Line	:	13904 GLOVER PLACE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-3126
Country	:	US
Telephone Number	:	813-417-5888
Fax Number	:	813-962-8350

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NUBIA ORJUELA
Credential	:
Telephone Number	:	813-417-5888

Provider Enumeration Date	:	09/28/2007
Last Update Date	:	05/27/2008

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