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General NPI Number Information
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NPI Number | 1982719852
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Entity Type | Organization
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Legal Business Name | GREEN RIVER HEART INSTITUTE, P.S.C.
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 07/23/2008
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Provider Practice Location Address
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Address Line | 815 E PARRISH AVE SUITE 240
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City | OWENSBORO
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State | KY
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Zip | 42303-3222
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Country | US
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Telephone | 270-688-0808
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Fax | 270-683-5806
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Provider Business Mailing Address
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Address Line | 815 E PARRISH AVE SUITE 240
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City | OWENSBORO
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State | KY
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Zip | 42303-3222
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Country | US
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Telephone | 270-688-0808
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Fax | 270-683-5806
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER J. HAVELDA
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Credential | M.D.
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Telephone | 270-688-0808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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