MEDICARE: HEART SPECIALISTS OF OHIO INC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184813057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART SPECIALISTS OF OHIO INC

Provider Business Mailing Address
First Line	:	3650 OLENTANGY RIVER RD
Second Line	:	SUITE 300
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3464
Country	:	US
Telephone Number	:	740-397-5400
Fax Number	:	740-397-0719

Provider Business Practice Location Address
First Line	:	1330 COSHOCTON RD
Second Line	:
City	:	MT VERNON
State	:	OH
Zip	:	43050-5416
Country	:	US
Telephone Number	:	614-538-0527
Fax Number	:	614-538-0530

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DOUGLAS VAN FOSSEN
Credential	:	M.D.
Telephone Number	:	614-538-0527

Provider Enumeration Date	:	10/17/2007
Last Update Date	:	10/31/2007

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