MEDICARE: CARDIOSCAN, 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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1760483630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOSCAN, INC.

Provider Business Mailing Address
First Line	:	PO BOX 667217
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77266-7217
Country	:	US
Telephone Number	:	713-520-5678
Fax Number	:	713-520-5678

Provider Business Practice Location Address
First Line	:	6560 FANNIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2725
Country	:	US
Telephone Number	:	713-796-1129
Fax Number	:	713-796-1526

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MRS. ANNA M GRATVOL
Credential	:
Telephone Number	:	713-520-5678

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	08/22/2020

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Directions to “CARDIOSCAN, INC. ” Practice Location

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