Healthcare Provider Details

I. General information

NPI: 1952590036
Provider Name (Legal Business Name): CARDIOLOGISTS OF CLARK & CHAMPAIGN COUNTIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E COURT ST
URBANA OH
43078-1887
US

IV. Provider business mailing address

1911 E HIGH ST
SPRINGFIELD OH
45505-1227
US

V. Phone/Fax

Practice location:
  • Phone: 937-653-8897
  • Fax: 937-653-7261
Mailing address:
  • Phone: 937-323-5064
  • Fax: 937-323-1404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. SUSAN KAE GABBARD
Title or Position: BILLING SUPERVISOR
Credential: CPC
Phone: 937-323-5064