1760692107 NPI number — CARDIAC CARE CENTER OF LOUISVILLE, PLLC

Table of content: (NPI 1760692107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760692107 NPI number — CARDIAC CARE CENTER OF LOUISVILLE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIAC CARE CENTER OF LOUISVILLE, PLLC
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:
MEDICAL CENTER CARDIOLOGISTS
Provider Other Organization Name Type Code:
3
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:
1760692107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 457
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40201-0457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-585-4321
Provider Business Mailing Address Fax Number:
502-895-6083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 ABRAHAM FLEXNER WAY
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-1846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-585-4321
Provider Business Practice Location Address Fax Number:
502-587-8306
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
JESSE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
502-585-4321

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207UN0901X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 78902657 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65901324 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 95900494 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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