Provider Demographics
NPI:1922109545
Name:HEART CENTER INC
Entity Type:Organization
Organization Name:HEART CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:VON DOHLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-647-2030
Mailing Address - Street 1:157 SKYLAR DR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-9359
Mailing Address - Country:US
Mailing Address - Phone:304-647-2030
Mailing Address - Fax:304-647-2033
Practice Address - Street 1:157 SKYLAR DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9359
Practice Address - Country:US
Practice Address - Phone:304-647-2030
Practice Address - Fax:304-647-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13305207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0073887000Medicaid
WVDH2496OtherRAILROAD MEDICARE
WV9365141Medicare PIN
WVD31190Medicare UPIN