MEDICARE: CARDIOSOM, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)	042508857	SC

General Provider Information

NPI Number	:	1033176011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOSOM, LLC

Provider Business Mailing Address
First Line	:	615 W. CARMEL DR.
Second Line	:	SUITE 100
City	:	CARMEL
State	:	IN
Zip	:	46032-5504
Country	:	US
Telephone Number	:	317-706-1080
Fax Number	:	317-574-8674

Provider Business Practice Location Address
First Line	:	1330 BOILING SPRINGS RD
Second Line	:	SUITE 2900
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-4201
Country	:	US
Telephone Number	:	864-529-3460
Fax Number	:	864-529-3461

Authorized Official
Title or Position	:	PRESIDENT/COO
Name	:	MR. JAY JARRELL
Credential	:
Telephone Number	:	317-706-1080

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	08/10/2010

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Directions to “CARDIOSOM, LLC ” Practice Location

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