Organization
MOBILE HEART STATION INC
Active
Other names
Mobile CV 2000 Inc
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WAR T VICHAYANOND PHD FASE RDCS (PRESIDENT & CEO)
(601) 799-5169
Entity
Organization
Contact information
Practice address
196 TIMBERLANE ROAD, PICAYUNE, MS 39466
(601) 799-5169
(601) 799-3998
Mailing address
196 TIMBERLANE ROAD, PICAYUNE, MS 39466
(601) 799-5169
(601) 799-3998
Taxonomy
Speciality
Code
Description
License number
State
246XC2903X
Vascular Specialist/Technologist Cardiovascular
Primary
ARDMS11532
—
246XS1301X
Sonography Specialist/Technologist Cardiovascular
ARDMS11532
—
2471S1302X
Sonography Radiologic Technologist
ARDMS
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00117333
—
MS
01
—
470000422
MEDICARE RAILROAD
MS
01
—
5CB82
MEDICARE OF LA
LA
Enumeration date
11/01/2006
Last updated
11/02/2010
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