Provider Demographics
NPI:1124292446
Name:THE HEART HOSPITAL AT DEACONESS GATEWAY, LLC
Entity type:Organization
Organization Name:THE HEART HOSPITAL AT DEACONESS GATEWAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-842-4783
Mailing Address - Street 1:PO BOX 3199
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47731-3199
Mailing Address - Country:US
Mailing Address - Phone:812-842-4784
Mailing Address - Fax:812-842-3921
Practice Address - Street 1:4007 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8947
Practice Address - Country:US
Practice Address - Phone:812-842-4784
Practice Address - Fax:812-842-3921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100103930Medicaid
IN200935230AMedicaid
IN200935230AMedicaid
IL========= 001Medicaid