Provider Demographics
NPI:1316024722
Name:CARDIOLOGY OF KENTUCKY
Entity Type:Organization
Organization Name:CARDIOLOGY OF KENTUCKY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:P
Authorized Official - Last Name:STACY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:502-897-7107
Mailing Address - Street 1:4003 KRESGE WAY STE 221
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4652
Mailing Address - Country:US
Mailing Address - Phone:502-897-7107
Mailing Address - Fax:502-897-7613
Practice Address - Street 1:4003 KRESGE WAY STE 221
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4652
Practice Address - Country:US
Practice Address - Phone:502-897-7107
Practice Address - Fax:502-897-7613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1050379Medicaid
KY2621Medicare ID - Type Unspecified