Provider Demographics
NPI:1154483097
Name:KENTUCKY HEART CARE, PSC
Entity Type:Organization
Organization Name:KENTUCKY HEART CARE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HIMACHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:VELIGANDLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-325-0011
Mailing Address - Street 1:2301 LEXINGTON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2873
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2301 LEXINGTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2873
Practice Address - Country:US
Practice Address - Phone:606-547-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40110174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000492275OtherANTHEM BLUE CROSS
KY000000492275OtherANTHEM BLUE CROSS