Provider Demographics
NPI:1184813057
Name:HEART SPECIALISTS OF OHIO INC
Entity type:Organization
Organization Name:HEART SPECIALISTS OF OHIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN FOSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-538-0527
Mailing Address - Street 1:3650 OLENTANGY RIVER RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3464
Mailing Address - Country:US
Mailing Address - Phone:740-397-5400
Mailing Address - Fax:740-397-0719
Practice Address - Street 1:1330 COSHOCTON RD
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-5416
Practice Address - Country:US
Practice Address - Phone:614-538-0527
Practice Address - Fax:614-538-0530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2462679Medicaid
OH9281756Medicare PIN