Provider Demographics
NPI:1245305515
Name:ELECTROPHYSIOLOGY AND PACING INTERVENTIONALISTS, LLC
Entity type:Organization
Organization Name:ELECTROPHYSIOLOGY AND PACING INTERVENTIONALISTS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:
Authorized Official - First Name:WENDE
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-425-5553
Mailing Address - Street 1:3433 AGLER RD
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-3387
Mailing Address - Country:US
Mailing Address - Phone:614-428-5553
Mailing Address - Fax:614-428-5515
Practice Address - Street 1:106 N MURRAY HILL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1524
Practice Address - Country:US
Practice Address - Phone:614-228-0491
Practice Address - Fax:614-228-1089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061758207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2817616Medicaid
OH2817616Medicaid
OHGU0698449Medicare ID - Type Unspecified