Healthcare Provider Details

I. General information

NPI: 1376686311
Provider Name (Legal Business Name): CHILDREN'S HEART SPECIALISTS, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 E BROADWAY
LOUISVILLE KY
40202-1711
US

IV. Provider business mailing address

743 E. BROADWAY #300
LOUISVILLE KY
40202
US

V. Phone/Fax

Practice location:
  • Phone: 502-584-3200
  • Fax: 502-584-3333
Mailing address:
  • Phone: 502-584-3200
  • Fax: 502-584-3333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number24893
License Number StateKY

VIII. Authorized Official

Name: DR. JUAN VILLAFANE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 502-584-3200