Healthcare Provider Details

I. General information

NPI: 1184813057
Provider Name (Legal Business Name): HEART SPECIALISTS OF OHIO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 COSHOCTON RD
MT VERNON OH
43050-5416
US

IV. Provider business mailing address

3650 OLENTANGY RIVER RD SUITE 300
COLUMBUS OH
43214-3464
US

V. Phone/Fax

Practice location:
  • Phone: 614-538-0527
  • Fax: 614-538-0530
Mailing address:
  • Phone: 740-397-5400
  • Fax: 740-397-0719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DOUGLAS VAN FOSSEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 614-538-0527