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General NPI Number Information
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NPI Number | 1902140791
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Entity Type | Organization
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Legal Business Name | CARDIOVASCULAR CONSULTANTS OF KENTUCKY, LLC
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Dates
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Enumeration Date | 11/16/2012
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Last Update Date | 10/16/2015
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Provider Practice Location Address
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Address Line | 191 WAL MART WAY
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City | MAYSVILLE
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State | KY
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Zip | 41056-7518
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Country | US
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Telephone | 859-744-0263
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Fax | 859-745-0836
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Provider Business Mailing Address
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Address Line | 191 WAL MART WAY
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City | MAYSVILLE
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State | KY
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Zip | 41056-7518
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Country | US
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Telephone | 859-744-0263
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Fax | 859-745-0836
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. MATHEW K SHOTWELL
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Credential | M.D.
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Telephone | 859-744-0263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3007563
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA562
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 35596
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License Number State | KY
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