| NPI | 1053559617 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARA MARKS Administrator 606-324-4745 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine Cardiovascular Disease |
| Additional Taxonomies | 207RC0001X Internal Medicine Clinical Cardiac Electrophysiology |
| 2086S0129X Surgery Vascular Surgery (Licence: KY TP119) | |
| 363LF0000X Nurse Practitioner Family (Licence: KY 6446P) | |
| Enumeration Date | 2009-02-04 |
| Last Update Date | 2010-07-26 |