Healthcare Provider Details

I. General information

NPI: 1083712467
Provider Name (Legal Business Name): OHIO VALLEY HEARTCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 LOCUST ST
ELDORADO IL
62930-1629
US

IV. Provider business mailing address

901 ST MARYS DR SUITE 300
EVANSVILLE IN
47714-8005
US

V. Phone/Fax

Practice location:
  • Phone: 812-473-2642
  • Fax:
Mailing address:
  • Phone: 812-473-2642
  • Fax: 812-474-4458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: KC FRESCOLN
Title or Position: CEO
Credential: CEO
Phone: 812-473-2642