Organization
CARDIO OF CLARK & CHAMPAIGN
Active
Parent organization
CARDIOLOGISTS OF CLARK & CHAMPAIGN COUNTIES INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
CARDIOLOGISTS OF CLARK & CHAMPAIGN COUNTIES INC
Authorized official
MS. SUSAN KAE GABBARD CPC (BILLING SUPERVISOR)
(937) 323-5064
Entity
Organization
Contact information
Practice address
1141 N MONROE DR, XENIA, OH 45385-1619
(937) 376-8336
(937) 376-8352
Mailing address
1911 E HIGH ST, SPRINGFIELD, OH 45505-1227
(937) 323-5064
(937) 323-1407
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0942412
—
OH
01
—
CM7602
RAILROAD MEDICARE
OH
Enumeration date
10/12/2007
Last updated
01/30/2008
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