Healthcare Provider Details

I. General information

NPI: 1164429635
Provider Name (Legal Business Name): DANVILLE CARDIOVASCULAR CONSULTANTS, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 BEN ALI DR
DANVILLE KY
40422-8937
US

IV. Provider business mailing address

1250 BEN ALI DR PO BOX 88
DANVILLE KY
40422-8937
US

V. Phone/Fax

Practice location:
  • Phone: 859-236-6621
  • Fax: 859-238-0471
Mailing address:
  • Phone: 859-236-6621
  • Fax: 859-238-0471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number27430
License Number StateKY

VIII. Authorized Official

Name: KATHLEEN S LOWERY
Title or Position: INS BILLING CLERK
Credential:
Phone: 859-236-6621