Provider Demographics
NPI:1023046927
Name:CARDIOVASCULAR ASSOCIATES PSC
Entity Type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-891-8300
Mailing Address - Street 1:PO BOX 20129
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40250-0129
Mailing Address - Country:US
Mailing Address - Phone:502-891-8300
Mailing Address - Fax:
Practice Address - Street 1:DOWELL ROAD
Practice Address - Street 2:
Practice Address - City:RUSSEL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-1610
Practice Address - Country:US
Practice Address - Phone:502-891-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCL0058OtherRAILROAD GROUP NUMBER
KY1090473OtherPASSPORT GROUP NUMBER
KY000000057322OtherANTHEM GROUP NUMBER
KY65900193OtherKY MEDICAID GROUP NUMBER
KY2435915000OtherPASSPORT ADVANTAGE GROUP
KY2435915000OtherPASSPORT ADVANTAGE GROUP
KY=========017OtherTRICARE GROUP NUMBER