Provider Demographics
NPI:1457322992
Name:NORTH OHIO HEART CENTER INC
Entity Type:Organization
Organization Name:NORTH OHIO HEART CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:THOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-930-4400
Mailing Address - Street 1:1220 MOORE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-4044
Mailing Address - Country:US
Mailing Address - Phone:440-930-4446
Mailing Address - Fax:440-934-0682
Practice Address - Street 1:3600 KOLBE RD
Practice Address - Street 2:SUITE 127
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1654
Practice Address - Country:US
Practice Address - Phone:440-204-4000
Practice Address - Fax:440-282-7579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207R00000X, 207RC0001X, 207RI0011X, 207VG0400X, 363LA2200X
OH207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB7049OtherRAILROAD MEDICARE GROUP
OH0547859Medicaid
OH0547859Medicaid