Healthcare Provider Details

I. General information

NPI: 1588835037
Provider Name (Legal Business Name): VASCULAR INSTITUTE OF KENTUCKY PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 23RD ST STE. 445
ASHLAND KY
41101-2880
US

IV. Provider business mailing address

PO BOX 2058
ASHLAND KY
41105-2058
US

V. Phone/Fax

Practice location:
  • Phone: 606-324-1070
  • Fax: 606-324-1071
Mailing address:
  • Phone: 606-324-1070
  • Fax: 606-324-1071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number39066
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3009186
License Number StateKY

VIII. Authorized Official

Name: ALEXANDER H HOU
Title or Position: PRESIDENT
Credential: MD
Phone: 606-324-1070