Provider Demographics
NPI:1194913293
Name:CLINICAL CARDIOLOGY SPECIALISTS, INC
Entity type:Organization
Organization Name:CLINICAL CARDIOLOGY SPECIALISTS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATON
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLIER-CRESPIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-459-7676
Mailing Address - Street 1:551 W CENTRAL AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1493
Mailing Address - Country:US
Mailing Address - Phone:740-368-5077
Mailing Address - Fax:740-368-5041
Practice Address - Street 1:551 W CENTRAL AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1493
Practice Address - Country:US
Practice Address - Phone:740-368-5077
Practice Address - Fax:740-368-5041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2330801Medicaid
OHCM1574OtherRAILROAD MEDICARE
OH2330801Medicaid