Provider Demographics
NPI:1740398254
Name:CARDIOLOGY ASSOCIATES OF PADUCAH, PSC
Entity Type:Organization
Organization Name:CARDIOLOGY ASSOCIATES OF PADUCAH, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-538-5500
Mailing Address - Street 1:PO BOX 7129
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-7129
Mailing Address - Country:US
Mailing Address - Phone:270-442-0103
Mailing Address - Fax:270-442-0109
Practice Address - Street 1:1532 LONE OAK RD
Practice Address - Street 2:SUITE 415
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7913
Practice Address - Country:US
Practice Address - Phone:270-442-0103
Practice Address - Fax:270-442-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65915704Medicaid
CM3393OtherRAILROAD MEDICARE
KY000000058935OtherBLUE SHIELD
KY0680Medicare PIN