Provider Demographics
NPI:1982719852
Name:GREEN RIVER HEART INSTITUTE, P.S.C.
Entity Type:Organization
Organization Name:GREEN RIVER HEART INSTITUTE, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAVELDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-688-0808
Mailing Address - Street 1:815 E PARRISH AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-3222
Mailing Address - Country:US
Mailing Address - Phone:270-688-0808
Mailing Address - Fax:270-683-5806
Practice Address - Street 1:815 E PARRISH AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3222
Practice Address - Country:US
Practice Address - Phone:270-688-0808
Practice Address - Fax:270-683-5806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65935561Medicaid
KY15E1OtherANTHEM BCBS
IN100006330AMedicaid
IN100006330AMedicaid
KY65935561Medicaid
KY15E1OtherANTHEM BCBS
KY8530Medicare PIN
KY8526Medicare PIN