Healthcare Provider Details

I. General information

NPI: 1801098512
Provider Name (Legal Business Name): OHIO INSTITUTE OF CARDIAC CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 S LIMESTONE ST
SPRINGFIELD OH
45505-3058
US

IV. Provider business mailing address

1010 S LIMESTONE ST
SPRINGFIELD OH
45505-3058
US

V. Phone/Fax

Practice location:
  • Phone: 937-325-1010
  • Fax: 937-325-5144
Mailing address:
  • Phone: 937-325-1010
  • Fax: 937-325-5144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. PATRICIA D BRASSE
Title or Position: CREDENTIALING REPRESENTATIVE
Credential:
Phone: 937-426-1518