Provider Demographics
NPI:1457382640
Name:MIAMI VALLEY HEART & LUNG SURGEONS, LLC
Entity type:Organization
Organization Name:MIAMI VALLEY HEART & LUNG SURGEONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:P
Authorized Official - Last Name:ANSTADT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-208-6060
Mailing Address - Street 1:30 E APPLE ST
Mailing Address - Street 2:SUITE 6252
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2939
Mailing Address - Country:US
Mailing Address - Phone:937-208-6060
Mailing Address - Fax:937-208-6061
Practice Address - Street 1:30 E APPLE ST
Practice Address - Street 2:SUITE 6252
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2939
Practice Address - Country:US
Practice Address - Phone:937-208-6060
Practice Address - Fax:937-208-6061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2427332Medicaid
OH2427332Medicaid