Organization
CHRISTIAN CARDIOLOGY INTERNAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS TERESA COLLATZ CEO (ADMINISTRATOR)
(606) 598-5807
Entity
Organization
Contact information
Practice address
113 MAIN ST, MANCHESTER, KY 40962-1258
(606) 598-5807
Mailing address
113 MAIN ST, PO BOX 159, MANCHESTER, KY 40962-1258
(606) 598-5807
(606) 599-8898
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65930133
—
KY
Enumeration date
10/24/2006
Last updated
08/22/2020
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