Provider Demographics
NPI:1144418526
Name:CARDIOVASCULAR IMAGING INC
Entity type:Organization
Organization Name:CARDIOVASCULAR IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THADDEUS
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:RDCS
Authorized Official - Phone:316-721-5495
Mailing Address - Street 1:12521 W KENNY CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-1956
Mailing Address - Country:US
Mailing Address - Phone:316-721-5495
Mailing Address - Fax:
Practice Address - Street 1:12521 W KENNY CIR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-1956
Practice Address - Country:US
Practice Address - Phone:316-721-5495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS130552Medicare PIN