Provider Demographics
NPI:1124011010
Name:THE HEART HEALTH CENTER CATH LAB, LLC
Entity Type:Organization
Organization Name:THE HEART HEALTH CENTER CATH LAB, LLC
Other - Org Name:THE HEART HEALTH CENTER CATH LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SOFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-993-6969
Mailing Address - Street 1:450 N NEW BALLAS RD
Mailing Address - Street 2:STE 170W
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6835
Mailing Address - Country:US
Mailing Address - Phone:314-993-6969
Mailing Address - Fax:314-993-0792
Practice Address - Street 1:450 N NEW BALLAS RD
Practice Address - Street 2:STE 170W
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6835
Practice Address - Country:US
Practice Address - Phone:314-993-6969
Practice Address - Fax:314-993-0792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC0615102207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1144214297OtherINDIV PROVIDER NPI P
MOP00275849OtherRAILROAD MEDICARE
MO1073506051OtherINDIV PROVIDER NPI MC
MO1821081712OtherINDIV PROVIDER NPI COLE
MO1831182807OtherINDIV PROVIDER NPI KOP