Healthcare Provider Details

I. General information

NPI: 1629663380
Provider Name (Legal Business Name): CARDIOVASCULAR IMAGING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 10/11/2021
Certification Date: 09/20/2021
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 TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: JOHN DAVID DELAPA
Title or Position: OWNER
Credential:
Phone: 740-894-7155