Basic Information
| Provider Information | |||||||||
| NPI: | 1649313164 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KENTUCKY CARDIOTHORACIC SURGICAL ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 HOSPITAL WAY STE 220 | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | KY | ||||||||
| PostalCode: | 425031877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064510300 | ||||||||
| FaxNumber: | 6064510595 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 HOSPITAL WAY STE 220 | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | KY | ||||||||
| PostalCode: | 425031877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064510300 | ||||||||
| FaxNumber: | 6064510595 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2007 | ||||||||
| LastUpdateDate: | 01/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | BAKHSHAY | ||||||||
| AuthorizedOfficialFirstName: | SHAHROUKH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 6064510300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D, | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | 38974 | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.