Basic Information
| Provider Information | |||||||||
| NPI: | 1003841396 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE HEART GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3963 LOOMIS PKWY | ||||||||
| Address2: | |||||||||
| City: | RAVENNA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442661800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302976110 | ||||||||
| FaxNumber: | 3302960592 | ||||||||
| Practice Location | |||||||||
| Address1: | 3963 LOOMIS PKWY | ||||||||
| Address2: | |||||||||
| City: | RAVENNA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442661800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302976110 | ||||||||
| FaxNumber: | 3302960592 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 11/05/2007 | ||||||||
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| AuthorizedOfficialLastName: | PARKER | ||||||||
| AuthorizedOfficialFirstName: | ANN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3303761500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 0966905 | 05 | OH | MEDICAID |