Organization
CARDIAC IMAGING CENTER, PLLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BASSAM MOUSHMOUSH M.D. (OWNER)
(304) 419-0395
Entity
Organization
Contact information
Practice address
331 LAIDLEY ST, SUITE 402, CHARLESTON, WV 25301-1619
(304) 419-0395
Mailing address
331 LAIDLEY ST, SUITE 402, CHARLESTON, WV 25301-1619
(304) 419-0395
Taxonomy
Speciality
Code
Description
License number
State
293D00000X
Physiological Laboratory
Primary
01010/4730849-01
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0073986000
—
WV
Enumeration date
01/15/2008
Last updated
01/15/2008
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