Basic Information
| Provider Information | |||||||||
| NPI: | 1063418473 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTERN KENTUCKY HEART & CHEST SURGERY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2601 KENTUCKY AVE | ||||||||
| Address2: | STE 300 | ||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420033826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704435564 | ||||||||
| FaxNumber: | 2704435549 | ||||||||
| Practice Location | |||||||||
| Address1: | 2601 KENTUCKY AVE | ||||||||
| Address2: | STE 300 | ||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420033826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704435564 | ||||||||
| FaxNumber: | 2704435549 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | HOWE | ||||||||
| AuthorizedOfficialFirstName: | W | ||||||||
| AuthorizedOfficialMiddleName: | ROBIN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2704435564 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.