Healthcare Provider Details

I. General information

NPI: 1205816832
Provider Name (Legal Business Name): INDIANA HEART HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8075 N SHADELAND AVE
INDIANAPOLIS IN
46250-2693
US

IV. Provider business mailing address

6233 RELIABLE PKWY
CHICAGO IL
60686-0062
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-8000
  • Fax: 317-621-8111
Mailing address:
  • Phone: 317-621-8000
  • Fax: 317-621-8111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number003312
License Number StateIN

VIII. Authorized Official

Name: MS. MARY GAMACHE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 317-621-8057