Provider Demographics
NPI:1609945914
Name:HEART INSTITUTE OF NORTH DAKOTA LTD
Entity Type:Organization
Organization Name:HEART INSTITUTE OF NORTH DAKOTA LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:N
Authorized Official - Last Name:CHELLIAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-780-2000
Mailing Address - Street 1:1191 S COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4033
Mailing Address - Country:US
Mailing Address - Phone:701-780-2000
Mailing Address - Fax:701-746-1663
Practice Address - Street 1:1191 S COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4033
Practice Address - Country:US
Practice Address - Phone:701-780-2000
Practice Address - Fax:701-746-1663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4722207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11461Medicaid
ND11461Medicaid
NDN71071Medicare PIN