MEDICARE: CARDIAC DIAGNOSITC SERVICES,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	261QH0100X	Health Service Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000537090	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1225198914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIAC DIAGNOSITC SERVICES,INC

Provider Business Mailing Address
First Line	:	4807 ROCKSIDE RD
Second Line	:	SUITE 610
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2192
Country	:	US
Telephone Number	:	216-503-5100
Fax Number	:	216-503-5099

Provider Business Practice Location Address
First Line	:	4807 ROCKSIDE RD
Second Line	:	SUITE 610
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2192
Country	:	US
Telephone Number	:	216-503-5100
Fax Number	:	216-503-5099

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RONALD P CIOCCA
Credential	:
Telephone Number	:	216-503-5100

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	04/24/2008

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