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General NPI Number Information
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NPI Number | 1376587733
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Entity Type | Organization
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Legal Business Name | SOUTHWEST CARDIOLOGY INC
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 02/11/2010
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Provider Practice Location Address
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Address Line | 8057 WASHINGTON VILLAGE DR
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City | CENTERVILLE
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State | OH
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Zip | 45458-1847
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Country | US
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Telephone | 937-312-9890
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Fax | 937-293-3605
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Provider Business Mailing Address
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Address Line | 3533 SOUTHERN BLVD SUITE 2100
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City | KETTERING
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State | OH
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Zip | 45429-1267
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Country | US
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Telephone | 937-293-3486
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Fax | 937-293-3605
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID B STULTZ
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Credential | MD
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Telephone | 937-293-3486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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