Provider Demographics
NPI:1316239262
Name:INDIANA HEART HOSPITAL LLC
Entity type:Organization
Organization Name:INDIANA HEART HOSPITAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MALSTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:3177-621-8000
Mailing Address - Street 1:6435 CASTLETON WEST DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1940
Mailing Address - Country:US
Mailing Address - Phone:317-621-0919
Mailing Address - Fax:317-355-9760
Practice Address - Street 1:14540 PRAIRIE LAKES BLVD NORTH
Practice Address - Street 2:SUITE 105
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-4370
Practice Address - Country:US
Practice Address - Phone:317-621-0370
Practice Address - Fax:317-621-0381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Single Specialty