Provider Demographics
NPI:1962580274
Name:THE CHILDRENS HEART CLINIC P,A
Entity type:Organization
Organization Name:THE CHILDRENS HEART CLINIC P,A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC OPERATIONS COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOSSIA
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-813-8801
Mailing Address - Street 1:2530 CHICAGO AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4291
Mailing Address - Country:US
Mailing Address - Phone:612-813-8800
Mailing Address - Fax:612-813-8825
Practice Address - Street 1:2530 CHICAGO AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4291
Practice Address - Country:US
Practice Address - Phone:612-813-8800
Practice Address - Fax:612-813-8825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty