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General NPI Number Information
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NPI Number | 1376700567
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Entity Type | Organization
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Legal Business Name | CARDIOVASCULAR CONSULTANTS, INC.
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Dates
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Enumeration Date | 05/16/2008
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 2021 WALES RD NE
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City | MASSILLON
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State | OH
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Zip | 44646-4186
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Country | US
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Telephone | 330-454-8076
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Fax | 330-454-3927
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Provider Business Mailing Address
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Address Line | 2600 6TH ST SW SUITE A2-710
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City | CANTON
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State | OH
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Zip | 44710-1702
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Country | US
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Telephone | 330-454-8076
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Fax | 330-454-3927
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | VIRGINIA MANFULL
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Credential |
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Telephone | 330-454-8076
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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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