Healthcare Provider Details

I. General information

NPI: 1346539541
Provider Name (Legal Business Name): KENTUCKY HEART INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 23RD ST SUITE 140
ASHLAND KY
41101-2878
US

IV. Provider business mailing address

PO BOX 2380
ASHLAND KY
41105-2380
US

V. Phone/Fax

Practice location:
  • Phone: 606-326-1675
  • Fax: 606-326-1436
Mailing address:
  • Phone: 606-326-1675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3007367
License Number StateKY

VIII. Authorized Official

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