Provider Demographics
NPI:1881883981
Name:HEART AND VASCULAR CLINIC, INC.
Entity type:Organization
Organization Name:HEART AND VASCULAR CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NADDOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-399-3222
Mailing Address - Street 1:1353 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6626
Mailing Address - Country:US
Mailing Address - Phone:330-399-3222
Mailing Address - Fax:330-399-3223
Practice Address - Street 1:1353 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6626
Practice Address - Country:US
Practice Address - Phone:330-399-3222
Practice Address - Fax:330-399-3223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHBN5678531174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2250139Medicaid
OH9348201Medicare PIN
OH2250139Medicaid