| Organization Name: | CARDIOSOM OF FT. WAYNE, INC |
| NPI Number: | 1003813692 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KEVIN PAUL GREISL (PRESIDENT) |
| Mailing Address: | 1625 Magnavox Way Ft Wayne |
| State: | IN US |
| Postal Code: | 468041535 |
| Phone Number: | 8888575337 |
| Fax Number: | 2604599247 |
| NPI Enumeration Date: | 06/28/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BX2000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Oxygen Equipment & Supplies |
| Taxonomy Definition: | |