Healthcare Provider Details

I. General information

NPI: 1578818704
Provider Name (Legal Business Name): CARDIO VASCULAR IMAGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 SHERBORNE DR
SPARTANBURG SC
29307-2941
US

IV. Provider business mailing address

118 SHERBORNE DR
SPARTANBURG SC
29307-2941
US

V. Phone/Fax

Practice location:
  • Phone: 478-246-1026
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. BROOKE SOLES
Title or Position: BILLING MANAGER
Credential:
Phone: 478-246-1026