1124292446 NPI number — THE HEART HOSPITAL AT DEACONESS GATEWAY, LLC

Table of content: (NPI 1124292446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124292446 NPI number — THE HEART HOSPITAL AT DEACONESS GATEWAY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE HEART HOSPITAL AT DEACONESS GATEWAY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124292446
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3199
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47731-3199
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-842-4784
Provider Business Mailing Address Fax Number:
812-842-3921

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4007 GATEWAY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWBURGH
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47630-8947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-842-4784
Provider Business Practice Location Address Fax Number:
812-842-3921
Provider Enumeration Date:
04/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MALOTTE
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
812-842-4783

Provider Taxonomy Codes

  • Taxonomy code: 284300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7100103930 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200935230A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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