Healthcare Provider Details

I. General information

NPI: 1235365537
Provider Name (Legal Business Name): KENTUCKY HEART INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 23RD ST SUITE 210
ASHLAND KY
41101-2878
US

IV. Provider business mailing address

PO BOX 2380
ASHLAND KY
41105-2380
US

V. Phone/Fax

Practice location:
  • Phone: 606-326-9847
  • Fax: 606-324-3418
Mailing address:
  • Phone: 606-326-9847
  • Fax: 606-324-3418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

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