1134279607 NPI number — HEART CENTER PC

Table of content: (NPI 1134279607)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134279607 NPI number — HEART CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEART CENTER PC
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:
1134279607
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
52 PARK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HYANNIS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02601-5206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-771-4205
Provider Business Mailing Address Fax Number:
508-771-7870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
52 PARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HYANNIS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02601-5206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-771-4205
Provider Business Practice Location Address Fax Number:
508-771-7870
Provider Enumeration Date:
01/10/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHIOTELLIS
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
N
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
508-771-4205

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110025502/B , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".