Provider Demographics
NPI:1700856119
Name:THE HEART TEAM
Entity Type:Organization
Organization Name:THE HEART TEAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WYNNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-329-1122
Mailing Address - Street 1:2400 PATTERSON ST
Mailing Address - Street 2:STE 223
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203
Mailing Address - Country:US
Mailing Address - Phone:615-329-1122
Mailing Address - Fax:615-329-9211
Practice Address - Street 1:2400 PATTERSON ST
Practice Address - Street 2:STE 223
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203
Practice Address - Country:US
Practice Address - Phone:615-329-1122
Practice Address - Fax:615-329-9211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370612Medicaid
TNDA0874OtherRAILROAD MEDICARE
TN10017047OtherAMERIGROUP COMMUNITY CARE
TN1444239OtherBCBS
TN1444239OtherBCBS