Provider Demographics
NPI:1346539541
Name:KENTUCKY HEART INSTITUTE
Entity Type:Organization
Organization Name:KENTUCKY HEART INSTITUTE
Other - Org Name:TRI-STATE VASCULAR SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-324-4745
Mailing Address - Street 1:PO BOX 2380
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2380
Mailing Address - Country:US
Mailing Address - Phone:606-326-1675
Mailing Address - Fax:
Practice Address - Street 1:613 23RD ST
Practice Address - Street 2:SUITE 140
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2878
Practice Address - Country:US
Practice Address - Phone:606-326-1675
Practice Address - Fax:606-326-1436
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENTUCKY HEART INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-29
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085R0202X, 2085R0204X, 2086S0129X, 363A00000X, 363L00000X, 363LA2200X
KY3007367363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810020985Medicaid
OH3135842Medicaid
KY7100164890Medicaid
KY7100162260Medicaid
WV3810020985Medicaid
OH9379841Medicare PIN