Provider Demographics
NPI:1992822563
Name:MIDDLETOWN CARDIOVASCULAR ASSOCIATES, INC.
Entity Type:Organization
Organization Name:MIDDLETOWN CARDIOVASCULAR ASSOCIATES, INC.
Other - Org Name:PROMED EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-783-4222
Mailing Address - Street 1:235 N BREIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3807
Mailing Address - Country:US
Mailing Address - Phone:513-783-4222
Mailing Address - Fax:513-217-6037
Practice Address - Street 1:235 N BREIEL BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3807
Practice Address - Country:US
Practice Address - Phone:513-783-4222
Practice Address - Fax:513-783-4477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2734885Medicaid
OHDF8005OtherRAILROAD MEDICARE
OH613397200OtherDEPT OF LABOR-ENERGY DIVISION ACS
OHDF8005OtherRAILROAD MEDICARE
OHMI9368151Medicare ID - Type UnspecifiedMEDICARE GROUP ID#