MEDICARE: INDIANA CARDIOVASCULAR SPECIALISTS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1134141849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANA CARDIOVASCULAR SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	15 SOUTH EIGHTH STREET
Second Line	:
City	:	INDIANA
State	:	PA
Zip	:	15701
Country	:	US
Telephone Number	:	724-463-9700
Fax Number	:	724-463-9702

Provider Business Practice Location Address
First Line	:	625 RUSTIC LODGE RD STE B
Second Line	:
City	:	INDIANA
State	:	PA
Zip	:	15701-3403
Country	:	US
Telephone Number	:	724-471-2334
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DIANA LEIGH METZGER
Credential	:	MD
Telephone Number	:	724-388-7124

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	05/15/2020

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