Provider Demographics
NPI:1760692107
Name:CARDIAC CARE CENTER OF LOUISVILLE, PLLC
Entity Type:Organization
Organization Name:CARDIAC CARE CENTER OF LOUISVILLE, PLLC
Other - Org Name:MEDICAL CENTER CARDIOLOGISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
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 457
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0457
Mailing Address - Country:US
Mailing Address - Phone:502-585-4321
Mailing Address - Fax:502-895-6083
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY
Practice Address - Street 2:SUITE 305
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1846
Practice Address - Country:US
Practice Address - Phone:502-585-4321
Practice Address - Fax:502-587-8306
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARDIAC CARE CENTER OF LOUISVILLE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-23
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78902657Medicaid
KY65901324Medicaid
KY95900494Medicaid
KY6908Medicare ID - Type UnspecifiedNDC
X65858Medicare UPIN
KY78902657Medicaid