Provider Demographics
| NPI: | 1134484892 |
|---|---|
| Name: | KINGS DAUGHTERS MEDICAL SPECIALTIES INC. |
| Entity Type: | Organization |
| Organization Name: | KINGS DAUGHTERS MEDICAL SPECIALTIES INC. |
| Other - Org Name: | KINGS DAUGHTERS MEDICAL SPECIALTIES - TSVS |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | CEO/PRESIDENT |
| Authorized Official - Prefix: | MRS |
| Authorized Official - First Name: | SARA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | MARKS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 606-408-4401 |
| Mailing Address - Street 1: | PO BOX 2379 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | ASHLAND |
| Mailing Address - State: | KY |
| Mailing Address - Zip Code: | 41105-2379 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 606-408-6200 |
| Mailing Address - Fax: | 606-408-6612 |
| Practice Address - Street 1: | 613 23RD ST STE 210 |
| Practice Address - Street 2: | |
| Practice Address - City: | ASHLAND |
| Practice Address - State: | KY |
| Practice Address - Zip Code: | 41101-2868 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 606-326-9847 |
| Practice Address - Fax: | 606-324-3418 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2012-07-09 |
| Last Update Date: | 2024-01-19 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RC0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | Group - Multi-Specialty |
| No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
| No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
| No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
| No | 2085R0204X | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | Group - Multi-Specialty |
| No | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Multi-Specialty |
| No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | Group - Multi-Specialty |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| KY | 01251 | Medicare PIN | |
| OH | 9386361 | Medicare PIN |
