Organization
INDIANA HEART HOSPITAL LLC
Active
Other names
Community Physicians
Organization subpart
No
Provider details
NPI number
Authorized official
HOLLY MILLARD (CFO)
(317) 621-9312
Entity
Organization
Contact information
Practice address
8075 N SHADELAND AVE, SUITE 200, INDIANAPOLIS, IN 46250-2693
(317) 621-9312
Mailing address
6626 E. 75TH STREET, SUITE 500, INDIANAPOLIS, IN 46250-2894
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207XP3100X
Pediatric Orthopaedic Surgery Physician
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000525347
ANTHEM
IN
05
—
200861380
—
IN
05
—
201033120
—
IN
Enumeration date
05/14/2007
Last updated
07/10/2014
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