Organization
CARDIOSOM, LLC
Active
Other names
CardioSom of Fort Wayne
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAY JARRELL (PRESIDENT/COO)
(317) 706-1080
Entity
Organization
Contact information
Practice address
1625 MAGNAVOX WAY, FORT WAYNE, IN 46804-1535
(260) 436-2261
(260) 436-0092
Mailing address
615 W. CARMEL DR., SUITE 100, CARMEL, IN 46032-5504
(317) 706-1080
(317) 574-8674
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
69000011A
IN
Other
Enumeration date
08/09/2006
Last updated
08/10/2010
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