Provider Demographics
NPI:1801126818
Name:COMPREHENSIVE CARDIOLOGY CONSULTANTS
Entity type:Organization
Organization Name:COMPREHENSIVE CARDIOLOGY CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WIETMARSCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-872-5700
Mailing Address - Street 1:311 STRAIGHT ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1018
Mailing Address - Country:US
Mailing Address - Phone:513-861-5555
Mailing Address - Fax:513-861-0999
Practice Address - Street 1:3325 GLENMORE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-6510
Practice Address - Country:US
Practice Address - Phone:513-861-5555
Practice Address - Fax:513-861-0524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047833207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0262193Medicaid
OH0528763Medicaid
OHWO0899243Medicare PIN
OHWO0520365Medicare PIN