Provider Demographics
NPI:1396938791
Name:OHIO INSTITUTE OF CARDIAC CARE, INC
Entity type:Organization
Organization Name:OHIO INSTITUTE OF CARDIAC CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALINC COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:DIETZ
Authorized Official - Last Name:BRASSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-429-2160
Mailing Address - Street 1:1117 E HOME RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2725
Mailing Address - Country:US
Mailing Address - Phone:937-390-8100
Mailing Address - Fax:937-390-8109
Practice Address - Street 1:1117 E HOME RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2725
Practice Address - Country:US
Practice Address - Phone:937-390-8100
Practice Address - Fax:937-390-8109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9253906Medicare PIN