Provider Demographics
NPI:1316085830
Name:PREFERRED VASCULAR DIAGNOSTICS INC.
Entity type:Organization
Organization Name:PREFERRED VASCULAR DIAGNOSTICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGWORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:RVT
Authorized Official - Phone:630-209-9161
Mailing Address - Street 1:425 S FINLEY RD
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2428
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 S. DRYDEN PL
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-6369
Practice Address - Country:US
Practice Address - Phone:630-209-9161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210986Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER