Healthcare Provider Details

I. General information

NPI: 1811900970
Provider Name (Legal Business Name): CARDIOVASCULAR ASSOCIATES OF SOUTHERN INDIANA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 GREEN VALLEY RD
NEW ALBANY IN
47150-4693
US

IV. Provider business mailing address

2109 GREEN VALLEY RD
NEW ALBANY IN
47150-4693
US

V. Phone/Fax

Practice location:
  • Phone: 812-948-2232
  • Fax: 812-945-0869
Mailing address:
  • Phone: 812-948-2232
  • Fax: 812-945-0869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number StateKY

VIII. Authorized Official

Name: KEVIN G HOLLIS
Title or Position: PRESIDENT
Credential: MD
Phone: 812-948-2232