Healthcare Provider Details

I. General information

NPI: 1205047818
Provider Name (Legal Business Name): EKG PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 N DIXIE AVE
ELIZABETHTOWN KY
42701-2503
US

IV. Provider business mailing address

3077 SOLUTIONS CTR
CHICAGO IL
60677-3000
US

V. Phone/Fax

Practice location:
  • Phone: 270-765-5921
  • Fax:
Mailing address:
  • Phone: 270-765-5921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JAVIER ARCE
Title or Position: PHYSICIAN AND OWNER
Credential:
Phone: 270-765-5921