MEDICARE: CARDIOSOM, LLC

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	332BX2000X	Oxygen Equipment & Supplies (DME)	69000010A	IN

General Provider Information

NPI Number	:	1881606812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOSOM, LLC

Provider Business Mailing Address
First Line	:	615 W. CARMEL DR
Second Line	:	SUITE 100
City	:	CARMEL
State	:	IN
Zip	:	46032-5504
Country	:	US
Telephone Number	:	317-706-1080
Fax Number	:	800-868-1908

Provider Business Practice Location Address
First Line	:	1350 E COUNTY LINE RD
Second Line	:	SUITE D
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-0873
Country	:	US
Telephone Number	:	317-883-2138
Fax Number	:	317-883-2207

Authorized Official
Title or Position	:	COOPRESIDENT
Name	:	KEVIN GREISL
Credential	:
Telephone Number	:	317-706-1080

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	10/25/2007

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Directions to “CARDIOSOM, LLC ” Practice Location

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