Healthcare Provider Details

I. General information

NPI: 1376642017
Provider Name (Legal Business Name): CARDIOVASCULAR IMAGING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 04/01/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 COUNTY ROAD 276
SOUTH POINT OH
45680-8912
US

IV. Provider business mailing address

189 COUNTY ROAD 276
SOUTH POINT OH
45680-8912
US

V. Phone/Fax

Practice location:
  • Phone: 740-894-7155
  • Fax: 740-894-3390
Mailing address:
  • Phone: 740-894-7155
  • Fax: 740-894-3390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number38261
License Number StateOH

VIII. Authorized Official

Name: JOHN DELAPA
Title or Position: OWNER
Credential: ARDMS, AART
Phone: 740-894-7155