Provider Demographics
NPI:1194936906
Name:HEART CENTER A PROFESSIONAL LLP
Entity type:Organization
Organization Name:HEART CENTER A PROFESSIONAL LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-475-2794
Mailing Address - Street 1:525 N FOOTE AVE
Mailing Address - Street 2:309
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-4554
Mailing Address - Country:US
Mailing Address - Phone:719-475-2794
Mailing Address - Fax:719-475-1458
Practice Address - Street 1:525 N FOOTE AVE
Practice Address - Street 2:309
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-4554
Practice Address - Country:US
Practice Address - Phone:719-475-2794
Practice Address - Fax:719-475-1458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04023875Medicaid
KS54583OtherBCBS
CC9064OtherMEMORIAL HEALTH SYSTEMS
CO16559264Medicaid
COC810432OtherMEMORIAL HEALTH SYSTEMS
COCG9404OtherRAILROAD MEDICARE
CO01237551Medicaid
KS100144980Medicaid
COCC5654OtherMEMORIAL HEALTH SYSTEMS
COCC5654OtherMEMORIAL HEALTH SYSTEMS
COC259508Medicare PIN
COCC9064Medicare PIN
CO04023875Medicaid