Fort Wayne Cardiology Corporation

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

Legal business name

FORT WAYNE CARDIOLOGY CORPORATION

Practice address

208 Columbus St
Hicksville, OH 43526

Phone

(260) 481-4700

Fax

(260) 481-4808

NPI assigned

Dec 16, 2005

Reactivated

Oct 11, 2007

Organization subpart

Yes

Parent organization

FORT WAYNE CARDIOLOGY CORPORATIONAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Polly Baloski

Title

Billing Manager

Phone

(260) 481-4700

Specialties & licenses 3

Addresses

Other identifiers 1

Tax ID family

Fort Wayne Cardiology Cor2 organizations share this tax ID, including this one

Part of

Fort Wayne Cardiology Cor

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Fort Wayne Cardiology Corporation

  • Cardiovascular Disease Physician
  • Paulding, OH
  • NPI 1669458733
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223337600000",
    "number": "1730165242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11829",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468611829",
            "telephone_number": "260-481-4700",
            "fax_number": "260-481-4808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 COLUMBUS ST",
            "city": "HICKSVILLE",
            "state": "OH",
            "postal_code": "43526",
            "telephone_number": "260-481-4700",
            "fax_number": "260-481-4808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WAYNE CARDIOLOGY CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FORT WAYNE CARDIOLOGY CORPORATION",
        "enumeration_date": "2005-12-16",
        "last_updated": "2008-10-07",
        "deactivation_date": "2007-08-09",
        "reactivation_date": "2007-10-11",
        "status": "A",
        "authorized_official_last_name": "BALOSKI",
        "authorized_official_first_name": "POLLY",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "260-481-4700"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200425420L",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Community Memorial Hospital
• Community Memorial Hospital
• Community Memorial Hospital
• Katlyn Nicole Craig
• Dekalb Memorial Hospital, Inc
• Matt Walter Grant
• Matthew C Grothaus, M.D.
• Ashley Guilford, R.D.
• Johnathan Robert Haggerty, D.C.
• Cory T Hammond, PA

• Cardiovascular Disease Physician in Hicksville, OH
• Providers in Hicksville, OH by specialty
• Cardiovascular Disease Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.