Provider Demographics
NPI:1265496483
Name:CENTRAL CARDIOLOGY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:CENTRAL CARDIOLOGY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-765-5921
Mailing Address - Street 1:1324 WOODLAND DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701
Mailing Address - Country:US
Mailing Address - Phone:270-765-5921
Mailing Address - Fax:270-769-0000
Practice Address - Street 1:1324 WOODLAND DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701
Practice Address - Country:US
Practice Address - Phone:270-765-5921
Practice Address - Fax:270-769-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65912859Medicaid
KY09599Medicare PIN
KY65912859Medicaid
KY6064Medicare PIN
KY00496Medicare PIN
KY00502Medicare PIN
KY2002Medicare PIN
KY6062Medicare PIN