Provider Demographics
NPI:1003088246
Name:CARDIOLOGY ASSOCIATES, PSC
Entity Type:Organization
Organization Name:CARDIOLOGY ASSOCIATES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-331-0774
Mailing Address - Street 1:900 MEDICAL VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3422
Mailing Address - Country:US
Mailing Address - Phone:859-331-0774
Mailing Address - Fax:859-426-4051
Practice Address - Street 1:20 N GRAND AVE
Practice Address - Street 2:STE 3
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-4106
Practice Address - Country:US
Practice Address - Phone:859-331-0774
Practice Address - Fax:859-426-4051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CL9164OtherPALMETTO GBA-RAILROAD MEDICARE
KY5519Medicare PIN