Provider Demographics
NPI:1952537219
Name:W M D HEART CARE, LLC
Entity Type:Organization
Organization Name:W M D HEART CARE, LLC
Other - Org Name:HEART CARE PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN CEO
Authorized Official - Prefix:
Authorized Official - First Name:ZILIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-900-8500
Mailing Address - Street 1:PO BOX 1455
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39130-1455
Mailing Address - Country:US
Mailing Address - Phone:601-664-2424
Mailing Address - Fax:601-664-6675
Practice Address - Street 1:100 WHISPER LAKE BLVD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-7881
Practice Address - Country:US
Practice Address - Phone:601-664-2424
Practice Address - Fax:601-664-6675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19834207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03229528Medicaid
1396701553OtherINDIVIDUAL NPI
1396701553OtherINDIVIDUAL NPI
MS302G700377Medicare PIN