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General NPI Number Information
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NPI Number | 1881606812
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Entity Type | Organization
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Legal Business Name | CARDIOSOM, LLC
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 10/25/2007
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Provider Practice Location Address
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Address Line | 1350 E COUNTY LINE RD SUITE D
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-0873
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Country | US
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Telephone | 317-883-2138
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Fax | 317-883-2207
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Provider Business Mailing Address
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Address Line | 615 W. CARMEL DR SUITE 100
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City | CARMEL
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State | IN
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Zip | 46032-5504
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Country | US
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Telephone | 317-706-1080
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Fax | 800-868-1908
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Authorized Official
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Title or Position | COOPRESIDENT
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Name | KEVIN GREISL
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Credential |
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Telephone | 317-706-1080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 69000010A
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License Number State | IN
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