Provider Demographics
NPI:1659328466
Name:SPRINGFIELD HEART SURGEONS LLC
Entity Type:Organization
Organization Name:SPRINGFIELD HEART SURGEONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SURENDER
Authorized Official - Middle Name:R
Authorized Official - Last Name:NERAVETLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-215-9076
Mailing Address - Street 1:1671 N LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2646
Mailing Address - Country:US
Mailing Address - Phone:937-324-5511
Mailing Address - Fax:937-398-0652
Practice Address - Street 1:1671 N LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2646
Practice Address - Country:US
Practice Address - Phone:937-324-5511
Practice Address - Fax:937-398-0652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2642868Medicaid
9361641Medicare UPIN