Basic Information
| Provider Information | |||||||||
| NPI: | 1831244086 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VINEYARD EKG BILLING ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 905 | ||||||||
| Address2: | |||||||||
| City: | FALMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085488989 | ||||||||
| FaxNumber: | 5085485789 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 HOSPITAL ROAD | ||||||||
| Address2: | |||||||||
| City: | OAK BLUFFS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086930410 | ||||||||
| FaxNumber: | 5085485789 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2007 | ||||||||
| LastUpdateDate: | 09/02/2016 | ||||||||
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| AuthorizedOfficialLastName: | SOUZA | ||||||||
| AuthorizedOfficialFirstName: | SHEILA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING AGENT CEO | ||||||||
| AuthorizedOfficialTelephone: | 5085488989 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | M17792 | 01 | MA | BLUE CROSS | OTHER |