JETTY HEART CLINIC OF THE INDIANA HEART HOSPITAL LLC NPI 1366690257

NPI Information

NPI: 1366690257
Provider Name: JETTY HEART CLINIC OF THE INDIANA HEART HOSPITAL LLC
Classification: Internal Medicine - 207RC0000X
Entity Type: Organization

Specialization: Cardiovascular Disease

Address:
1210 MEDICAL ARTS BLVD
SUITE 217
ANDERSON, IN
ZIP 46011
Phone: (765) 298-4422
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JETTY HEART CLINIC OF THE INDIANA HEART HOSPITAL LLC is a cardiovascular disease internal medicine in Anderson, IN. The provider is an internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. JETTY HEART CLINIC OF THE INDIANA HEART HOSPITAL LLC NPI is 1366690257. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1210 MEDICAL ARTS BLVD
SUITE 217
ANDERSON, IN
ZIP 46011-439
Phone: (765) 298-4422
Fax: (765) 298-4926

The provider's authorized official is Thomas A Malasto .
The authorized official title is Ceo and has the following contact phone number (317) 621-8050.

The enumeration date for this NPI number is 9/4/2008 and was last updated on 10/21/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207RC0000X	Internal Medicine	Cardiovascular Disease	01040154A	INDIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	258000	MEDICARE PIN	INDIANA
2	000000586511	OTHER	INDIANA	ANTHEM

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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