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General NPI Number Information
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NPI Number | 1942233366
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Entity Type | Organization
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Legal Business Name | HEART, LUNG, AND VASCULAR SURGERY, PSC
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2737 GREENBACK RD
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City | UTICA
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State | KY
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Zip | 42376-9742
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Country | US
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Telephone | 937-479-6999
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Fax |
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Provider Business Mailing Address
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Address Line | 2737 GREENBACK RD
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City | UTICA
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State | KY
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Zip | 42376-9742
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Country | US
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Telephone | 937-479-6999
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN C POWELL
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Credential | MD
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Telephone | 937-479-6999
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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 | 29420
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License Number State | KY
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