Provider Demographics
NPI:1396758710
Name:HEART CARE ASSOCIATES PSC
Entity type:Organization
Organization Name:HEART CARE ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BHASKARAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:SREEKUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-821-0677
Mailing Address - Street 1:44 MCCOY AVENUE, BOX # 9
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-2871
Mailing Address - Country:US
Mailing Address - Phone:270-821-0677
Mailing Address - Fax:270-821-2539
Practice Address - Street 1:44 MCCOY AVENUE, BOX # 9
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-2871
Practice Address - Country:US
Practice Address - Phone:270-821-0677
Practice Address - Fax:270-821-2539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33663207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64336639Medicaid
KY0629104Medicare ID - Type Unspecified
KY64336639Medicaid