1124011010 NPI number — THE HEART HEALTH CENTER CATH LAB, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124011010 NPI number — THE HEART HEALTH CENTER CATH LAB, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE HEART HEALTH CENTER CATH LAB, 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:
6
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:
1124011010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 N NEW BALLAS RD
Provider Second Line Business Mailing Address:
STE 170W
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63141-6835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-993-6969
Provider Business Mailing Address Fax Number:
314-993-0792

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 N NEW BALLAS RD
Provider Second Line Business Practice Location Address:
STE 170W
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141-6835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-993-6969
Provider Business Practice Location Address Fax Number:
314-993-0792
Provider Enumeration Date:
08/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SOFFER
Authorized Official First Name:
ALLEN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
314-993-6969

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  LC0615102 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1144214297 . This is a "INDIV PROVIDER NPI P" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: P00275849 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1073506051 . This is a "INDIV PROVIDER NPI MC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1821081712 . This is a "INDIV PROVIDER NPI COLE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1831182807 . This is a "INDIV PROVIDER NPI KOP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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