Basic Information
| Provider Information | |||||||||
| NPI: | 1871545004 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PATIENT CHOICE CARDIOLOGY, P.S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | L6099 | ||||||||
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| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452706099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593313353 | ||||||||
| FaxNumber: | 8593313326 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 MEDICAL VILLAGE DR | ||||||||
| Address2: | STE. 177 | ||||||||
| City: | EDGEWOOD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410175401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593313353 | ||||||||
| FaxNumber: | 8593313326 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 03/29/2010 | ||||||||
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| AuthorizedOfficialLastName: | LIERL | ||||||||
| AuthorizedOfficialFirstName: | JERRY | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8593313353 | ||||||||
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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 | 207RC0000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | DE7424 | 01 | KY | RAILROAD MEDICARE | OTHER | 65944886 | 05 | KY | MEDICAID |