Provider Demographics
NPI:1437300910
Name:ST. ELIZABETH CARDIAC CATH LAB, LLC
Entity Type:Organization
Organization Name:ST. ELIZABETH CARDIAC CATH LAB, LLC
Other - Org Name:THE HEART LAB AT ST. ELIZABETH'S
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIZER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, MSOL
Authorized Official - Phone:330-480-3797
Mailing Address - Street 1:PO BOX 537
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44501-0537
Mailing Address - Country:US
Mailing Address - Phone:330-480-3998
Mailing Address - Fax:330-480-3498
Practice Address - Street 1:1044 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1006
Practice Address - Country:US
Practice Address - Phone:330-480-3998
Practice Address - Fax:330-480-3498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2459692Medicaid
OH2459692Medicaid
OHP00092224Medicare PIN