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General NPI Number Information
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NPI Number | 1801098512
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Entity Type | Organization
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Legal Business Name | OHIO INSTITUTE OF CARDIAC CARE, INC.
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 06/24/2009
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Provider Practice Location Address
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Address Line | 1010 S LIMESTONE ST
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City | SPRINGFIELD
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State | OH
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Zip | 45505-3058
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Country | US
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Telephone | 937-325-1010
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Fax | 937-325-5144
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Provider Business Mailing Address
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Address Line | 1010 S LIMESTONE ST
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City | SPRINGFIELD
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State | OH
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Zip | 45505-3058
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Country | US
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Telephone | 937-325-1010
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Fax | 937-325-5144
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Authorized Official
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Title or Position | CREDENTIALING REPRESENTATIVE
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Name | MS. PATRICIA D BRASSE
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Credential |
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Telephone | 937-426-1518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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