Provider Demographics
NPI:1376686311
Name:CHILDREN'S HEART SPECIALISTS, PSC
Entity Type:Organization
Organization Name:CHILDREN'S HEART SPECIALISTS, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLAFANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-584-3200
Mailing Address - Street 1:743 E. BROADWAY
Mailing Address - Street 2:#300
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-584-3200
Mailing Address - Fax:502-584-3333
Practice Address - Street 1:731 E BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1711
Practice Address - Country:US
Practice Address - Phone:502-584-3200
Practice Address - Fax:502-584-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY248932080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64248933Medicaid
IN100020940Medicaid
KY1052899OtherPASSPORT
KY1052899OtherPASSPORT
KY1517001Medicare PIN