Provider Demographics
NPI:1083667927
Name:THE HEART GROUP, PC
Entity Type:Organization
Organization Name:THE HEART GROUP, PC
Other - Org Name:HENDERSON LAB AND X-RAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEPSIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-464-0521
Mailing Address - Street 1:1413 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2768
Mailing Address - Country:US
Mailing Address - Phone:270-826-6277
Mailing Address - Fax:270-827-8735
Practice Address - Street 1:415 W COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1656
Practice Address - Country:US
Practice Address - Phone:812-464-0521
Practice Address - Fax:812-464-0521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200135291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000061910OtherANTHEM
KY3790382000Medicaid
IN100022660Medicaid
IL=========001Medicaid
KY3790382000Medicaid
KY4014201Medicare ID - Type UnspecifiedKY MCR