Provider Demographics
NPI:1063756278
Name:HEART CARE INSTITUTE AFFILIATED SERVICES, LLC
Entity type:Organization
Organization Name:HEART CARE INSTITUTE AFFILIATED SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:EGHIGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-273-0770
Mailing Address - Street 1:1020 N MASON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6300
Mailing Address - Country:US
Mailing Address - Phone:314-996-3140
Mailing Address - Fax:314-996-3132
Practice Address - Street 1:1020 N MASON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6300
Practice Address - Country:US
Practice Address - Phone:314-996-3140
Practice Address - Fax:314-996-3132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0404XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Cardiac Facilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
DV4787OtherRR MEDICARE PIN
DV4787OtherRR MEDICARE PIN