Healthcare Provider Details

I. General information

NPI: 1053559617
Provider Name (Legal Business Name): KENTUCKY HEART INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 23RD ST SUITE G-10
ASHLAND KY
41101-2878
US

IV. Provider business mailing address

PO BOX 1237
ASHLAND KY
41105-1237
US

V. Phone/Fax

Practice location:
  • Phone: 606-329-1997
  • Fax:
Mailing address:
  • Phone: 606-329-1997
  • Fax:

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 Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberTP119
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6446P
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: SARA MARKS
Title or Position: ADMINISTRATOR
Credential:
Phone: 606-324-4745