Healthcare Provider Details

I. General information

NPI: 1972531879
Provider Name (Legal Business Name): CARDIOVASCULAR ASSOCIATES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 W HEBRON LN SUITE 202
SHEPHERDSVILLE KY
40165-7425
US

IV. Provider business mailing address

PO BOX 20129
LOUISVILLE KY
40250-0129
US

V. Phone/Fax

Practice location:
  • Phone: 502-891-8300
  • Fax:
Mailing address:
  • Phone: 502-891-8300
  • 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: JANET L SMITH
Title or Position: MANAGING PHYSICIAN
Credential: MD
Phone: 502-891-8300