Provider Demographics
NPI:1871640201
Name:KENTUCKY CARDIOTHORACIC SURGERY PLLC
Entity Type:Organization
Organization Name:KENTUCKY CARDIOTHORACIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:POLLOCK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:502-810-8002
Mailing Address - Street 1:PO BOX 7565
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40257-0565
Mailing Address - Country:US
Mailing Address - Phone:502-810-8002
Mailing Address - Fax:
Practice Address - Street 1:3900 KRESGE WAY
Practice Address - Street 2:SUITE 46
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4660
Practice Address - Country:US
Practice Address - Phone:502-810-8002
Practice Address - Fax:502-810-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0543246208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9590074200Medicaid
KY65937914Medicaid
KY7228Medicare PIN