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NPI Code Detail

MEDICARE: HEARN VASCULAR, INC.

MEDICARE: HEARN VASCULAR, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12086S0129XVascular Surgery PhysicianOH

General Provider Information

NPI Number : 1235130725
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEARN VASCULAR, INC.
Provider Business Mailing Address
First Line : PO BOX 567
Second Line :
City : CHAGRIN FALLS
State : OH
Zip : 44022-0567
Country : US
Telephone Number : 216-464-5160
Fax Number : 216-464-5982
Provider Business Practice Location Address
First Line : 2422 LAKE AVE
Second Line :
City : ASHTABULA
State : OH
Zip : 44004-4985
Country : US
Telephone Number : 440-997-6933
Fax Number : 440-997-6916
Authorized Official
Title or Position : PRESIDENT
Name : ANDREW T HEARN
Credential : M.D.
Telephone Number : 440-997-6916
Provider Enumeration Date : 08/09/2005
Last Update Date : 07/21/2022

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