Healthcare Provider Details

I. General information

NPI: 1639426802
Provider Name (Legal Business Name): THE RUBIN HEART CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 SUNNY ISLE STE 9
CHRISTIANSTED VI
00820-4493
US

IV. Provider business mailing address

2095 EXETER RD STE 80
GERMANTOWN TN
38138-3919
US

V. Phone/Fax

Practice location:
  • Phone: 340-778-1802
  • Fax: 340-778-6460
Mailing address:
  • Phone: 901-728-3910
  • Fax: 901-206-2216

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: LIZA V RUBIN
Title or Position: ADMINISTRATION
Credential:
Phone: 901-752-5661