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General NPI Number Information
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NPI Number | 1376686311
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Entity Type | Organization
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Legal Business Name | CHILDREN'S HEART SPECIALISTS, PSC
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 06/11/2014
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Provider Practice Location Address
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Address Line | 731 E BROADWAY
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City | LOUISVILLE
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State | KY
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Zip | 40202-1711
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Country | US
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Telephone | 502-584-3200
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Fax | 502-584-3333
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Provider Business Mailing Address
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Address Line | 743 E. BROADWAY #300
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City | LOUISVILLE
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State | KY
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Zip | 40202
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Country | US
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Telephone | 502-584-3200
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Fax | 502-584-3333
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUAN VILLAFANE
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Credential | M.D.
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Telephone | 502-584-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 24893
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License Number State | KY
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