Organization
COMMONWEALTH CARDIOLOGISTS PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN T MCCLANAHAN (PRACTICE MANAGER)
(502) 584-2029
Entity
Organization
Contact information
Practice address
210 E GRAY ST, SUITE 1002, LOUISVILLE, KY 40202-3900
(502) 584-2029
(502) 584-0873
Mailing address
210 E GRAY ST, SUITE 1002, LOUISVILLE, KY 40202-3900
(502) 584-2029
(502) 584-0873
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100019450
—
IN
01
—
1050407
KY GROUP PASSPORT
KY
01
—
2432852000
KY PASSPORT ADVANTAGE
KY
05
—
65919896
—
KY
Enumeration date
08/11/2006
Last updated
09/02/2008
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