MEDICARE: CARDIOVASCULAR CONSULTANTS OF MARION PC

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	207RC0000X	Cardiovascular Disease Physician	02001087A	IN

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

General Provider Information

NPI Number	:	1639569171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOVASCULAR CONSULTANTS OF MARION PC

Provider Business Mailing Address
First Line	:	1123 N WESTERN AVE
Second Line	:
City	:	MARION
State	:	IN
Zip	:	46952-2501
Country	:	US
Telephone Number	:	765-651-9347
Fax Number	:	765-651-9346

Provider Business Practice Location Address
First Line	:	1123 N WESTERN AVE
Second Line	:
City	:	MARION
State	:	IN
Zip	:	46952-2501
Country	:	US
Telephone Number	:	765-651-9347
Fax Number	:	765-651-9346

Authorized Official
Title or Position	:	OWNER
Name	:	GARY ALLEN FRICK
Credential	:	DO
Telephone Number	:	765-651-9347

Provider Enumeration Date	:	02/04/2015
Last Update Date	:	02/04/2015

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