1578729109 NPI number — KENTUCKY HEART INSTITUTE

Table of content: (NPI 1578729109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578729109 NPI number — KENTUCKY HEART INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENTUCKY HEART INSTITUTE
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:
KENTUCKY HEART & VASCULAR PHYSICIANS
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:
1578729109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2380
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHLAND
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41105-2380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-324-4745
Provider Business Mailing Address Fax Number:
606-326-0165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
613 23RD ST
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-2878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-324-4745
Provider Business Practice Location Address Fax Number:
606-325-0134
Provider Enumeration Date:
08/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MARKS
Authorized Official First Name:
SARA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
606-324-4745

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: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; 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: 7100051970 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810013225 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2868384 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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