Provider Demographics
NPI:1063426062
Name:CARDIOLOGY ASSOCIATES OF SOUTHEASTERN OHIO INC.
Entity type:Organization
Organization Name:CARDIOLOGY ASSOCIATES OF SOUTHEASTERN OHIO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ELMAN
Authorized Official - Last Name:VANGILDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-454-0804
Mailing Address - Street 1:751 FOREST AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2868
Mailing Address - Country:US
Mailing Address - Phone:740-454-0804
Mailing Address - Fax:740-454-7171
Practice Address - Street 1:751 FOREST AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2868
Practice Address - Country:US
Practice Address - Phone:740-454-0804
Practice Address - Fax:740-454-7171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1111626174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2159355Medicaid
OH2159355Medicaid
OH9307371Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER