Provider Demographics
NPI:1801098512
Name:OHIO INSTITUTE OF CARDIAC CARE, INC.
Entity type:Organization
Organization Name:OHIO INSTITUTE OF CARDIAC CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING REPRESENTATIVE
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRASSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-426-1518
Mailing Address - Street 1:1010 S LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-3058
Mailing Address - Country:US
Mailing Address - Phone:937-325-1010
Mailing Address - Fax:937-325-5144
Practice Address - Street 1:1010 S LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-3058
Practice Address - Country:US
Practice Address - Phone:937-325-1010
Practice Address - Fax:937-325-5144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0382198Medicaid
OH9253905Medicare PIN