Healthcare Provider Details

I. General information

NPI: 1154531515
Provider Name (Legal Business Name): CARDIAC CARE CENTER OF LOUISVILLE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 NEW MOODY LN SUITE 101
LAGRANGE KY
40031-9177
US

IV. Provider business mailing address

PO BOX 457
LOUISVILLE KY
40201-0457
US

V. Phone/Fax

Practice location:
  • Phone: 502-222-4557
  • Fax: 502-222-5821
Mailing address:
  • Phone: 502-585-4321
  • Fax: 502-895-6083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSE E ADAMS III
Title or Position: OWNER PARTNER
Credential: M.D.
Phone: 502-585-4321