Provider Demographics
NPI:1619024312
Name:HEART SPECIALISTS OF OHIO, INC
Entity Type:Organization
Organization Name:HEART SPECIALISTS OF OHIO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/TREASURER, MANAGING PARTN
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:MURCKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-538-0527
Mailing Address - Street 1:651 W MARION RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-1027
Mailing Address - Country:US
Mailing Address - Phone:419-947-9953
Mailing Address - Fax:
Practice Address - Street 1:651 W MARION RD
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-1027
Practice Address - Country:US
Practice Address - Phone:419-947-9953
Practice Address - Fax:419-946-9958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0235598Medicaid
=========01OtherBWC
OH0235598Medicaid