1811067747 NPI number — HEART AND VASCULAR DIAGNOSTIC CLINIC, LLC

Table of content: DR. EMMANUELA HENRIETTE WOLLOCH M.D. (NPI 1619016391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811067747 NPI number — HEART AND VASCULAR DIAGNOSTIC CLINIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEART AND VASCULAR DIAGNOSTIC CLINIC, 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:
1811067747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 PATTERSON ST
Provider Second Line Business Mailing Address:
SUITE 215
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37203-1562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-884-4425
Provider Business Mailing Address Fax Number:
615-342-5891

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1407 N. LOCUST AVENUE
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
LAWRENCEBURG
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-762-4333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROSEMAN
Authorized Official First Name:
HAL
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
CARDIOLOGOST
Authorized Official Telephone Number:
615-884-4425

Provider Taxonomy Codes

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

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





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