Provider Demographics
NPI:1376583237
Name:NORTHSIDE CARDIAC CATH LAB PARTNERSHIP
Entity Type:Organization
Organization Name:NORTHSIDE CARDIAC CATH LAB PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LANA
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-338-6666
Mailing Address - Street 1:8333 NAAB RD
Mailing Address - Street 2:STE 180B
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5924
Mailing Address - Country:US
Mailing Address - Phone:317-338-9001
Mailing Address - Fax:317-338-9045
Practice Address - Street 1:8333 NAAB RD
Practice Address - Street 2:STE 180B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5924
Practice Address - Country:US
Practice Address - Phone:317-338-9001
Practice Address - Fax:317-338-9045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCN0743OtherRAILROAD MEDICARE
INCN0743OtherRAILROAD MEDICARE