Healthcare Provider Details

I. General information

NPI: 1780763078
Provider Name (Legal Business Name): HEARTLAND ENT & ALLERGY CENTER, P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 FINANCIAL DRIVE, SUITE 104
ELIZABETHTOWN KY
42701-8450
US

IV. Provider business mailing address

101 FINANCIAL DRIVE, SUITE 104
ELIZABETHTOWN KY
42701-8450
US

V. Phone/Fax

Practice location:
  • Phone: 270-765-5127
  • Fax: 270-765-5337
Mailing address:
  • Phone: 270-765-5127
  • Fax: 270-765-5337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KIRO J YUN
Title or Position: OWNER
Credential: MD
Phone: 270-765-5127