Provider Demographics
NPI:1659304582
Name:ELYRIA CARDIAC CATH LAB, LLC
Entity Type:Organization
Organization Name:ELYRIA CARDIAC CATH LAB, LLC
Other - Org Name:THE NORTH OHIO HEART LAB AT EMH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:Q
Authorized Official - Last Name:CASSIDY-DRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:440-329-4910
Mailing Address - Street 1:630 E RIVER ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-5902
Mailing Address - Country:US
Mailing Address - Phone:440-329-4900
Mailing Address - Fax:440-329-4998
Practice Address - Street 1:630 E RIVER ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-5902
Practice Address - Country:US
Practice Address - Phone:440-329-4900
Practice Address - Fax:440-329-4998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2700018Medicaid
OH2700018Medicaid