Basic Information
| Provider Information | |||||||||
| NPI: | 1326086869 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDIOLOGY CONSULTANTS OF ZANESVILLE,LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1246 ASHLAND AVE | ||||||||
| Address2: | STE 107 | ||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437012861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404547725 | ||||||||
| FaxNumber: | 7404547728 | ||||||||
| Practice Location | |||||||||
| Address1: | 1246 ASHLAND AVE | ||||||||
| Address2: | STE 107 | ||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437012861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404547725 | ||||||||
| FaxNumber: | 7404547728 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | TOM | ||||||||
| AuthorizedOfficialFirstName: | DIXIE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7404547725 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 1594310 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 1265418255 | 01 | OH | NPI | OTHER | 1588640569 | 01 | OH | NPI | OTHER |