| Name | Value |
|---|---|
| PROVIDER TYPE | Technologists, Technicians & Other Technical Service Providers |
| CLASSIFICATION | Specialist/Technologist Cardiovascular |
| AREA OF SPECIALIZATION | Cardiovascular Invasive Specialist |
| STATUS | Active |
| VA CODE | V151201 |
| X12 CODE | 246XC2901X |
| INDIVIDUAL/NON | INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5255567 |
| EFFECTIVE DATE/TIME |
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