Provider Demographics
NPI:1386079556
Name:SOUTHERN KENTUCKY HEART INSTITUTE,PSC
Entity type:Organization
Organization Name:SOUTHERN KENTUCKY HEART INSTITUTE,PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:T
Authorized Official - Last Name:SCHWENDER
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:901-590-8632
Mailing Address - Street 1:1848 LYDA AVE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3361
Mailing Address - Country:US
Mailing Address - Phone:270-495-1484
Mailing Address - Fax:270-495-1488
Practice Address - Street 1:1848 LYDA AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3361
Practice Address - Country:US
Practice Address - Phone:270-495-1484
Practice Address - Fax:270-495-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42271174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100080740Medicaid