1659598159 NPI number — LOUISVILLE HEART SURGERY, PLLC

Table of content: (NPI 1659598159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659598159 NPI number — LOUISVILLE HEART SURGERY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOUISVILLE HEART SURGERY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659598159
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2355 POPLAR LEVEL RD
Provider Second Line Business Mailing Address:
SUITE 305
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40217-1395
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-634-0072
Provider Business Mailing Address Fax Number:
502-636-7130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2355 POPLAR LEVEL RD
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40217-1395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-634-0072
Provider Business Practice Location Address Fax Number:
502-636-7130
Provider Enumeration Date:
04/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ATTUM
Authorized Official First Name:
ABDUL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
502-634-0072

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10000011510A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com