MEDICARE: MANSFIELD CARDIOLOGY AND INTERNISTS, 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	207R00000X	Internal Medicine Physician	3542607	OH

General Provider Information

NPI Number	:	1831123033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANSFIELD CARDIOLOGY AND INTERNISTS, INC.

Provider Business Mailing Address
First Line	:	275 CLINE AVE
Second Line	:	SUITE 1
City	:	MANSFIELD
State	:	OH
Zip	:	44907-1019
Country	:	US
Telephone Number	:	419-756-2177
Fax Number	:	419-756-4258

Provider Business Practice Location Address
First Line	:	275 CLINE AVE
Second Line	:	SUITE 1
City	:	MANSFIELD
State	:	OH
Zip	:	44907-1019
Country	:	US
Telephone Number	:	419-756-2177
Fax Number	:	419-756-4258

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. SUSAN DAWN COLE
Credential	:
Telephone Number	:	419-756-2177

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	11/20/2007

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