1003088246 NPI number — CARDIOLOGY ASSOCIATES, PSC

Table of content: BRYAN HENSS D.C. (NPI 1033531876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003088246 NPI number — CARDIOLOGY ASSOCIATES, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOLOGY ASSOCIATES, PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003088246
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 MEDICAL VILLAGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDGEWOOD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41017-3422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-331-0774
Provider Business Mailing Address Fax Number:
859-426-4051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 N GRAND AVE
Provider Second Line Business Practice Location Address:
STE 3
Provider Business Practice Location Address City Name:
FORT THOMAS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41075-4106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-331-0774
Provider Business Practice Location Address Fax Number:
859-426-4051
Provider Enumeration Date:
03/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PATIL
Authorized Official First Name:
SANJAY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
859-331-0774

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CL9164 . This is a "PALMETTO GBA-RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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