=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215041603
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARDIO OPTIONS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2006
-----------------------------------------------------
Last Update Date | 01/23/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12627 SAN JOSE BLVD SUITE 205
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32223-2662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-268-6679
-----------------------------------------------------
Fax | 904-425-3236
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12627 SAN JOSE BLVD SUITE 205
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32223-2662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-268-6679
-----------------------------------------------------
Fax | 904-425-3236
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | MR. JACK LEEMOND BOYD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 904-268-6679
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246W00000X
-----------------------------------------------------
Taxonomy Name | Cardiology Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------