Basic Information
| Provider Information | |||||||||
| NPI: | 1780891804 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INDIANA HEART PHYSICIANS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 710 | ||||||||
| Address2: | |||||||||
| City: | BEECH GROVE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461070710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178931880 | ||||||||
| FaxNumber: | 3178931881 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 W WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | SHELBYVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461761236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178931900 | ||||||||
| FaxNumber: | 3178931901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 05/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | BENJAMIN | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 3178931900 | ||||||||
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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 | 100073370A | 05 | IN | MEDICAID |