Provider Demographics
NPI:1770773194
Name:CARDIOSOM, LLC
Entity type:Organization
Organization Name:CARDIOSOM, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTCOO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREISL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-706-1080
Mailing Address - Street 1:615 W CARMEL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2996
Mailing Address - Country:US
Mailing Address - Phone:800-868-1920
Mailing Address - Fax:800-868-1908
Practice Address - Street 1:523 CENTRE VIEW BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3444
Practice Address - Country:US
Practice Address - Phone:859-341-6333
Practice Address - Fax:859-341-1480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5348030021Medicare NSC