Provider Demographics
NPI:1811900970
Name:CARDIOVASCULAR ASSOCIATES OF SOUTHERN INDIANA, PC
Entity type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATES OF SOUTHERN INDIANA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:HOLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-948-2232
Mailing Address - Street 1:2109 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4693
Mailing Address - Country:US
Mailing Address - Phone:812-948-2232
Mailing Address - Fax:812-945-0869
Practice Address - Street 1:2109 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4693
Practice Address - Country:US
Practice Address - Phone:812-948-2232
Practice Address - Fax:812-945-0869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207RI0011X, 207RC0000X
KY207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty