Provider Demographics
NPI:1649313164
Name:KENTUCKY CARDIOTHORACIC SURGICAL ASSOCIATES
Entity type:Organization
Organization Name:KENTUCKY CARDIOTHORACIC SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SHAHROUKH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKHSHAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:606-451-0300
Mailing Address - Street 1:350 HOSPITAL WAY STE 220
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-1877
Mailing Address - Country:US
Mailing Address - Phone:606-451-0300
Mailing Address - Fax:606-451-0595
Practice Address - Street 1:350 HOSPITAL WAY STE 220
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-1877
Practice Address - Country:US
Practice Address - Phone:606-451-0300
Practice Address - Fax:606-451-0595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38974208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9364Medicare ID - Type UnspecifiedMEDICARE GROUP ID