Provider Demographics
NPI:1487781449
Name:PEDIATRIC CARDIOLOGY ASSOCIATES
Entity type:Organization
Organization Name:PEDIATRIC CARDIOLOGY ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:SOBCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-585-4802
Mailing Address - Street 1:601 S FLOYD ST
Mailing Address - Street 2:STE 602
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1835
Mailing Address - Country:US
Mailing Address - Phone:502-585-4802
Mailing Address - Fax:502-589-1256
Practice Address - Street 1:601 SOUTH FLOYD STREET
Practice Address - Street 2:STE 602
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-585-4802
Practice Address - Fax:502-589-1256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5428OtherANTHEM INSURANCE
KY65906463Medicaid
IN100312350AOtherINDIANA MEDICAID
KY1049837OtherPASSPORT
IN100312350AOtherINDIANA MEDICAID