Basic Information
| Provider Information | |||||||||
| NPI: | 1821155839 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE HEART CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3041 | ||||||||
| Address2: | |||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407433041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068644040 | ||||||||
| FaxNumber: | 6068643500 | ||||||||
| Practice Location | |||||||||
| Address1: | 181 OLD WHITLEY RD | ||||||||
| Address2: | |||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407448211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068644040 | ||||||||
| FaxNumber: | 6068643500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 10/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | BANKS | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6068644040 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | RN,BSN,MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | KY | N | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 261QM2500X | KY | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
ID Information
| ID | Type | State | Issuer | Description | 65937294 | 05 | KY | MEDICAID |