=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609945914
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEART INSTITUTE OF NORTH DAKOTA LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2006
-----------------------------------------------------
Last Update Date | 10/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1191 S COLUMBIA RD
-----------------------------------------------------
City | GRAND FORKS
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58201-4033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-780-2000
-----------------------------------------------------
Fax | 701-746-1663
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1191 S COLUMBIA RD
-----------------------------------------------------
City | GRAND FORKS
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58201-4033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-780-2000
-----------------------------------------------------
Fax | 701-746-1663
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | NOAH N CHELLIAH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 701-780-2000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 4722
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------