Healthcare Provider Details

I. General information

NPI: 1154596690
Provider Name (Legal Business Name): CARDIOVASCULAR IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5606 2ND ST
HOKES BLUFF AL
35903
US

IV. Provider business mailing address

5606 2ND ST
HOKES BLUFF AL
35903
US

V. Phone/Fax

Practice location:
  • Phone: 225-667-0380
  • Fax:
Mailing address:
  • Phone: 225-667-0380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH JUDE BROWN
Title or Position: OWNER VASCULAR TECHNOLOGIST
Credential:
Phone: 225-667-0380