Provider Demographics
NPI:1205047818
Name:EKG PSC
Entity type:Organization
Organization Name:EKG PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-765-5921
Mailing Address - Street 1:3077 SOLUTIONS CTR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-3000
Mailing Address - Country:US
Mailing Address - Phone:270-765-5921
Mailing Address - Fax:
Practice Address - Street 1:913 N DIXIE AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2503
Practice Address - Country:US
Practice Address - Phone:270-765-5921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1083705OtherPASSPORT
KY65914590Medicaid
000000059614OtherANTHEM BCBS
CF7923OtherRAILROAD MEDICARE
2435631000OtherPASSPORT ADVANTAGE
KY2125Medicare ID - Type Unspecified