Provider Demographics
NPI:1780919886
Name:HEART CARE LLC
Entity type:Organization
Organization Name:HEART CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUBHASH
Authorized Official - Middle Name:K
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-432-7000
Mailing Address - Street 1:7806 W JEFFERSON BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4180
Mailing Address - Country:US
Mailing Address - Phone:260-432-7000
Mailing Address - Fax:260-969-9119
Practice Address - Street 1:7806 W JEFFERSON BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4180
Practice Address - Country:US
Practice Address - Phone:260-432-7000
Practice Address - Fax:260-969-9119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200975120AMedicaid
IN200975120BMedicaid
IN200975120BMedicaid