Healthcare Provider Details

I. General information

NPI: 1316239262
Provider Name (Legal Business Name): INDIANA HEART HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14540 PRAIRIE LAKES BLVD NORTH SUITE 105
NOBLESVILLE IN
46060-4370
US

IV. Provider business mailing address

6435 CASTLETON WEST DRIVE SUITE 200
INDIANAPOLIS IN
46250-1940
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-0370
  • Fax: 317-621-0381
Mailing address:
  • Phone: 317-621-0919
  • Fax: 317-355-9760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS A MALSTO
Title or Position: CEO
Credential:
Phone: 31776218000