Healthcare Provider Details

I. General information

NPI: 1306942727
Provider Name (Legal Business Name): HEART INSTITUTE OF NORTHWEST OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 10/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 COMMERCE PKWY SUITE 100
LIMA OH
45804-4040
US

IV. Provider business mailing address

951 COMMERCE PKWY SUITE 100
LIMA OH
45804-4040
US

V. Phone/Fax

Practice location:
  • Phone: 419-224-5915
  • Fax: 419-228-2016
Mailing address:
  • Phone: 419-224-5915
  • Fax: 419-228-2016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2252584
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer
# 2
IdentifierCH7860
Identifier TypeOTHER
Identifier State
Identifier IssuerRAILROAD MEDICARE

VIII. Authorized Official

Name: DR. A PIERRE BAMDAD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 419-224-5915