Provider Demographics
NPI:1336295062
Name:HEARTLAND CARDIOTHORACIC SURGERY PLLC
Entity Type:Organization
Organization Name:HEARTLAND CARDIOTHORACIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HYMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-234-1982
Mailing Address - Street 1:1107 CROWN POINTE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7123
Mailing Address - Country:US
Mailing Address - Phone:270-234-1982
Mailing Address - Fax:270-234-1952
Practice Address - Street 1:1107 CROWN POINTE DR
Practice Address - Street 2:SUITE C
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7123
Practice Address - Country:US
Practice Address - Phone:270-234-1982
Practice Address - Fax:270-234-1952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29525208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY39K3OtherANTHEM GROUP PIN
KY1848701Medicare ID - Type Unspecified