Healthcare Provider Details

I. General information

NPI: 1942231196
Provider Name (Legal Business Name): CARDIAC STUDY CENTER INC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 SOUTH CEDAR ST SUITE 301
TACOMA WA
98405
US

IV. Provider business mailing address

1901 SOUTH CEDAR ST SUITE 301
TACOMA WA
98405
US

V. Phone/Fax

Practice location:
  • Phone: 253-572-7320
  • Fax: 253-627-3191
Mailing address:
  • Phone: 253-572-7320
  • Fax: 253-627-3191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateWA

VIII. Authorized Official

Name: JASON PARKS
Title or Position: CEO
Credential:
Phone: 253-396-4806