MEDICARE: CARDIO OPTIONS INC.

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	246W00000X	Cardiology Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	259067	OTHER	FL	AVMED PROVIDER NUMBER

General Provider Information

NPI Number	:	1215041603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIO OPTIONS INC.

Provider Business Mailing Address
First Line	:	12627 SAN JOSE BLVD
Second Line	:	SUITE 205
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-2662
Country	:	US
Telephone Number	:	904-268-6679
Fax Number	:	904-425-3236

Provider Business Practice Location Address
First Line	:	12627 SAN JOSE BLVD
Second Line	:	SUITE 205
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-2662
Country	:	US
Telephone Number	:	904-268-6679
Fax Number	:	904-425-3236

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MR. JACK LEEMOND BOYD
Credential	:
Telephone Number	:	904-268-6679

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	01/23/2013

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Directions to “CARDIO OPTIONS INC. ” Practice Location

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