Provider Demographics
NPI:1124140843
Name:THE INDIANA HEART HOSPITAL
Entity type:Organization
Organization Name:THE INDIANA HEART HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MALASTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-621-8050
Mailing Address - Street 1:3771 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-8738
Mailing Address - Country:US
Mailing Address - Phone:317-326-3056
Mailing Address - Fax:317-621-8571
Practice Address - Street 1:8075 N SHADELAND AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2693
Practice Address - Country:US
Practice Address - Phone:317-621-8569
Practice Address - Fax:317-621-8571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28087669A281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
INS62784Medicare UPIN
IN898190NNNMedicare ID - Type Unspecified