MEDICAL CENTER CARDIOLOGISTS, PSC

Provider Demographics

• NPI: 1689885782
• Name: MEDICAL CENTER CARDIOLOGISTS, PSC
• Entity Type: Organization
• Organization Name: MEDICAL CENTER CARDIOLOGISTS, PSC
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - Prefix: DR
• Authorized Official - First Name: JESSE
• Authorized Official - Middle Name: E
• Authorized Official - Last Name: ADAMS
• Authorized Official - Suffix: III
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 502-585-4321
• Mailing Address - Street 1: PO BOX 2409
• Mailing Address - City: LOUISVILLE
• Mailing Address - State: KY
• Mailing Address - Zip Code: 40201-2409
• Mailing Address - Country: US
• Mailing Address - Phone: 502-585-4321
• Mailing Address - Fax: 502-895-6083
• Practice Address - Street 1: 400 EXECUTIVE PARK
• Practice Address - City: LOUISVILLE
• Practice Address - State: KY
• Practice Address - Zip Code: 40207-4204
• Practice Address - Country: US
• Practice Address - Phone: 502-585-4321
• Practice Address - Fax: 502-895-6083
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2007-05-24
• Last Update Date: 2007-11-12

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207RC0000X	Allopathic & Osteopathic Physicians	Internal Medicine	Cardiovascular Disease	Group - Multi-Specialty
No	207RC0001X	Allopathic & Osteopathic Physicians	Internal Medicine	Clinical Cardiac Electrophysiology	Group - Multi-Specialty
No	207RI0011X	Allopathic & Osteopathic Physicians	Internal Medicine	Interventional Cardiology	Group - Multi-Specialty
No	207UN0901X	Allopathic & Osteopathic Physicians	Nuclear Medicine	Nuclear Cardiology	Group - Multi-Specialty
No	363AM0700X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant	Medical	Group - Multi-Specialty
No	363LA2100X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Acute Care	Group - Multi-Specialty
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
KY	65908808	Medicaid
KY	78902632	Medicaid
KY	CA8894	Other	RAILROAD MEDICARE
KY	2432239000	Medicaid
KY	95900502	Medicaid
IN	CB5788	Other	RAILROAD MEDICARE
KY	1048829	Medicaid
KY	78902632	Medicaid
KY	6465	Medicare PIN
IN	150690	Medicare PIN
KY	2893	Medicare PIN
KY	9555	Medicare PIN
	W00046	Medicare UPIN
KY	2732	Medicare PIN
KY	95900502	Medicaid
KY	65908808	Medicaid
KY	1048829	Medicaid