Provider Demographics
NPI:1427226893
Name:INDIANA HEART HOSPITAL LLC
Entity Type:Organization
Organization Name:INDIANA HEART HOSPITAL LLC
Other - Org Name:COMMUNITY CARDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MALASTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-621-8050
Mailing Address - Street 1:920 N SHADELAND AVE
Mailing Address - Street 2:SUITE G1
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4898
Mailing Address - Country:US
Mailing Address - Phone:317-355-9783
Mailing Address - Fax:317-355-9760
Practice Address - Street 1:1210B MEDICAL ARTS BLVD
Practice Address - Street 2:SUITE 217
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3461
Practice Address - Country:US
Practice Address - Phone:765-298-4422
Practice Address - Fax:765-298-4926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200539450BMedicaid
IN200539450BMedicaid