Provider Demographics
NPI:1073592572
Name:HEART CENTER OF SOMERSET PLLC
Entity Type:Organization
Organization Name:HEART CENTER OF SOMERSET PLLC
Other - Org Name:THE HEART CENTER OF SOMERSET, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:IBRAIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:IQBAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-677-1112
Mailing Address - Street 1:104 HARDIN LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-3800
Mailing Address - Country:US
Mailing Address - Phone:606-677-1112
Mailing Address - Fax:606-679-1341
Practice Address - Street 1:104 HARDIN LN
Practice Address - Street 2:SUITE B
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3800
Practice Address - Country:US
Practice Address - Phone:606-677-1112
Practice Address - Fax:606-679-1341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000336184OtherBCBS
KY64082605Medicaid
KY1214392OtherCHA HEALTH
KYP00147774OtherPALMETTO GBA
KYG86573Medicare UPIN
KY64082605Medicaid
KY1214392OtherCHA HEALTH
KY9262Medicare PIN