1437335494 NPI number — INDIANA HEART AND VASCULAR INSTITUTE PC

Table of content: (NPI 1437335494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437335494 NPI number — INDIANA HEART AND VASCULAR INSTITUTE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIANA HEART AND VASCULAR INSTITUTE 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:
1437335494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1225 E COOLSPRING AVE
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
MICHIGAN CITY
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46360-6312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-861-8170
Provider Business Mailing Address Fax Number:
219-871-7520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1225 E COOLSPRING AVE
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
MICHIGAN CITY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46360-6312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-861-8170
Provider Business Practice Location Address Fax Number:
219-871-7520
Provider Enumeration Date:
01/21/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ESPAR
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
219-874-1400

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  01041339A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000552910 . This is a "ANTHEME BC/BS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200890550A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".