Provider Demographics
NPI:1992738314
Name:CENTRAL PENNSYLVANIA CARDIOLOGY ASSOCIATES LLC
Entity type:Organization
Organization Name:CENTRAL PENNSYLVANIA CARDIOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:HEID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-524-4211
Mailing Address - Street 1:131 JPM RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9309
Mailing Address - Country:US
Mailing Address - Phone:570-524-4211
Mailing Address - Fax:570-524-4255
Practice Address - Street 1:131 JPM RD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9309
Practice Address - Country:US
Practice Address - Phone:570-524-4211
Practice Address - Fax:570-524-4255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD011806E207RC0000X
PAMD027347E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006601640002Medicaid
PA0010510310003Medicaid
PA0010510310003Medicaid
PA081673PYLMedicare ID - Type UnspecifiedDR HEID
C31361Medicare UPIN
PA136359PYLMedicare ID - Type UnspecifiedDR SMITH