Provider Demographics
NPI:1275735953
Name:OHIO INSTITUTE OF CARDIAC CARE, INC.
Entity Type:Organization
Organization Name:OHIO INSTITUTE OF CARDIAC CARE, INC.
Other - Org Name:ADVANCED CARDIOLOGY
Other - Org Type:Doing Business As
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 1:9000 N MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1180
Mailing Address - Country:US
Mailing Address - Phone:937-832-1095
Mailing Address - Fax:937-836-4474
Practice Address - Street 1:9000 N MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1180
Practice Address - Country:US
Practice Address - Phone:937-832-1095
Practice Address - Fax:937-836-4474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9304994Medicare PIN