Provider Demographics
NPI:1043429962
Name:MEDICAL CENTER CARDIOLOGISTS, PSC
Entity Type:Organization
Organization Name:MEDICAL CENTER CARDIOLOGISTS, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:502-585-4321
Mailing Address - Street 1:PO BOX 2409
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-2409
Mailing Address - Country:US
Mailing Address - Phone:502-585-4321
Mailing Address - Fax:502-895-6083
Practice Address - Street 1:1578 HIGHWAY 44 E
Practice Address - Street 2:SUITE 2
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-7172
Practice Address - Country:US
Practice Address - Phone:502-585-4321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL CENTER CARDIOLOGISTS, PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-21
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95900502Medicaid
KY78902632Medicaid
KY65908808Medicaid
KY65908808Medicaid
KY95900502Medicaid