Provider Demographics
NPI:1124299615
Name:MID AMERICA HEART, PC
Entity type:Organization
Organization Name:MID AMERICA HEART, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LINTZENICH
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:618-632-1495
Mailing Address - Street 1:310 N SEVEN HILLS RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-4111
Mailing Address - Country:US
Mailing Address - Phone:618-632-1495
Mailing Address - Fax:618-628-0480
Practice Address - Street 1:310 N SEVEN HILLS RD
Practice Address - Street 2:SUITE 150
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-4111
Practice Address - Country:US
Practice Address - Phone:618-632-1495
Practice Address - Fax:618-628-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty