Organization
CARDIO TERRA, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY JOE BOLEY M.D. (MEMBER)
(614) 850-0081
Entity
Organization
Contact information
Practice address
4112 MONROE RD, CELINA, OH 45822-9250
(567) 890-9000
(567) 890-9009
Mailing address
4112 MONROE RD, CELINA, OH 45822-9250
(567) 890-9000
(567) 890-9009
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
307108
—
OH
Enumeration date
11/12/2013
Last updated
01/08/2014
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