Basic Information
| Provider Information | |||||||||
| NPI: | 1316239262 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INDIANA HEART HOSPITAL LLC | ||||||||
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| OtherOrganizationName: | COMMUNITY PEDICATRIC ORTHOPEDICS AND SPORTS MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6435 CASTLETON WEST DRIVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462501940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176210919 | ||||||||
| FaxNumber: | 3173559760 | ||||||||
| Practice Location | |||||||||
| Address1: | 14540 PRAIRIE LAKES BLVD NORTH | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | NOBLESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460604370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176210370 | ||||||||
| FaxNumber: | 3176210381 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2011 | ||||||||
| LastUpdateDate: | 05/11/2011 | ||||||||
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| AuthorizedOfficialLastName: | MALSTO | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 31776218000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XP3100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Pediatric Orthopaedic Surgery |
No ID Information.