Provider Demographics
NPI:1891886925
Name:GENERAL THORACIC AND VASCULAR SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:GENERAL THORACIC AND VASCULAR SURGICAL ASSOCIATES
Other - Org Name:OHIO VALLEY SURGICAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:S
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-683-3720
Mailing Address - Street 1:2801 NEW HARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303
Mailing Address - Country:US
Mailing Address - Phone:270-683-3720
Mailing Address - Fax:270-686-7331
Practice Address - Street 1:2801 NEW HARTFORD RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303
Practice Address - Country:US
Practice Address - Phone:270-683-3720
Practice Address - Fax:270-686-7331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200139810Medicaid
KY000000059316OtherANTHEM
KY65925521Medicaid
KY000000059316OtherANTHEM