Basic Information
| Provider Information | |||||||||
| NPI: | 1396989208 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNT CARMEL HEALTH PROVIDERS TWO, LLC | ||||||||
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| OtherOrganizationName: | MC HEARTLAND CARDIOLOGY CVL2 | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6150 E BROAD ST | ||||||||
| Address2: | 2ND FLOOR ROOM WE201 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432131574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145464400 | ||||||||
| FaxNumber: | 6145464441 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 MORRIS RD | ||||||||
| Address2: | |||||||||
| City: | CIRCLEVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431131362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404748818 | ||||||||
| FaxNumber: | 7404778676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2009 | ||||||||
| LastUpdateDate: | 04/22/2009 | ||||||||
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| AuthorizedOfficialLastName: | MOYER | ||||||||
| AuthorizedOfficialFirstName: | BRITTANY | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | IMPLEMENTATION SPECIALSIT | ||||||||
| AuthorizedOfficialTelephone: | 6145464672 | ||||||||
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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 |
No ID Information.