Provider Demographics
NPI:1588835037
Name:VASCULAR INSTITUTE OF KENTUCKY PSC
Entity Type:Organization
Organization Name:VASCULAR INSTITUTE OF KENTUCKY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:H
Authorized Official - Last Name:HOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-324-1070
Mailing Address - Street 1:PO BOX 2058
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2058
Mailing Address - Country:US
Mailing Address - Phone:606-324-1070
Mailing Address - Fax:606-324-1071
Practice Address - Street 1:617 23RD ST
Practice Address - Street 2:STE. 445
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2880
Practice Address - Country:US
Practice Address - Phone:606-324-1070
Practice Address - Fax:606-324-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY390662086S0129X
KY3009186363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2557255Medicaid
KY64100548Medicaid
WV3810007120Medicaid
P00335402OtherRR MEDICARE
9966OtherFEDERAL MEDICARE GROUP
000000392596OtherANTHEM BCBS
WV3810007120Medicaid
000000392596OtherANTHEM BCBS