Basic Information
| Provider Information | |||||||||
| NPI: | 1104244409 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LMH HEART INSTITUTE OF NORTHWEST OHIO, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 951 COMMERCE PKWY | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458044040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199984575 | ||||||||
| FaxNumber: | 4199984586 | ||||||||
| Practice Location | |||||||||
| Address1: | 1132 HAGER ST | ||||||||
| Address2: | |||||||||
| City: | SAINT MARYS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458852423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192245915 | ||||||||
| FaxNumber: | 4192245918 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2014 | ||||||||
| LastUpdateDate: | 07/08/2016 | ||||||||
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| AuthorizedOfficialLastName: | TRAN | ||||||||
| AuthorizedOfficialFirstName: | KHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF MEDICAL AFFAIRS | ||||||||
| AuthorizedOfficialTelephone: | 4199984455 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LMH HEART INSTITUTE OF NORTHWEST OHIO, LLC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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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 | 0062268 | 05 | OH | MEDICAID | 1437423787 | 01 | OH | NPI | OTHER |