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General NPI Number Information
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NPI Number | 1346411188
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Entity Type | Organization
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Legal Business Name | KENTUCKIANA THORACIC & VASCULAR SURGERY. P.C/
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Dates
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Enumeration Date | 03/20/2008
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Last Update Date | 07/25/2008
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Provider Practice Location Address
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Address Line | 1919 STATE ST SUITE 364
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City | NEW ALBANY
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State | IN
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Zip | 47150-4929
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Country | US
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Telephone | 812-949-8355
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Fax | 812-949-4941
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Provider Business Mailing Address
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Address Line | 1919 STATE ST SUITE 364
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City | NEW ALBANY
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State | IN
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Zip | 47150-4929
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Country | US
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Telephone | 812-949-8355
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Fax | 812-949-4941
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. FRANCO RALPH REA
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Credential | M.D.
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Telephone | 812-949-8355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 04712
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 27240
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License Number State | KY
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