# MARYMOUNT MEDICAL CENTER PHYSICIAN SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** London Cardio-Vascular Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588797401
- **Authorized official:** KANDI RENEE REA (PHYSICIAN CREDENTIALING)
- **Authorized official phone:** (606) 877-3931

## Contact information

- **Practice address:** 803 MEYERS BAKER RD, STE 150, LONDON, KY 40741-3039
- **Practice address phone:** (606) 862-9280
- **Practice address fax:** (606) 877-3978
- **Mailing address:** 740 E LAUREL RD, LONDON, KY 40741-8601
- **Mailing address phone:** (606) 877-3931
- **Mailing address fax:** (606) 877-3978

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | NULL | Yes |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/13/2007
- **Last updated:** 08/22/2020