Provider Demographics
NPI:1801806963
Name:KENTUCKY HEART AND VASCULAR SPECIALISTS, PSC
Entity type:Organization
Organization Name:KENTUCKY HEART AND VASCULAR SPECIALISTS, PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:EL-SHIKEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-769-2929
Mailing Address - Street 1:1320 WOODLAND DR
Mailing Address - Street 2:A
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701
Mailing Address - Country:US
Mailing Address - Phone:270-769-2929
Mailing Address - Fax:270-769-0344
Practice Address - Street 1:1320 WOODLAND DR
Practice Address - Street 2:A
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701
Practice Address - Country:US
Practice Address - Phone:270-769-2929
Practice Address - Fax:270-769-0344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33792261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64337926Medicaid
KY0696502Medicare PIN
KYG62454Medicare UPIN
KY64337926Medicaid