Marymount Medical Center Physician Services

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

Legal business name

MARYMOUNT MEDICAL CENTER PHYSICIAN SERVICES

Doing business as

London Cardio-Vascular Surgery

Practice address

803 Meyers Baker Rd
Ste 150
London, KY 40741-3039

Phone

(606) 862-9280

Fax

(606) 877-3978

NPI assigned

Mar 13, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kandi Renee Rea

Title

Physician Credentialing

Phone

(606) 877-3931

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• London Cardio-Vascular Surgery Doing business as

Tax ID family

Marymount Medical Center Physician Services3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Marymount Medical Center Physician Services

  • Primary Care Clinic/Center
  • London, KY
  • NPI 1043501091
  NPD tax ID
• Marymount Medical Center Physician Services

  dba MMC Physician Services

  • Certified Registered Nurse Anesthetist
  • London, KY
  • NPI 1215133988
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1588797401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "740 E LAUREL RD",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407418601",
            "telephone_number": "606-877-3931",
            "fax_number": "606-877-3978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 MEYERS BAKER RD",
            "address_2": "STE 150",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407413039",
            "telephone_number": "606-862-9280",
            "fax_number": "606-877-3978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYMOUNT MEDICAL CENTER PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "REA",
        "authorized_official_first_name": "KANDI",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "PHYSICIAN CREDENTIALING",
        "authorized_official_telephone_number": "606-877-3931"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM GROUP",
            "identifier": "000000377922",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65938177",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "London Cardio-Vascular Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cydney Marcum
• Virginia Ann Marcum, APRN
• Briana Nicole Martin
• Marymount Medical Center Physician Services
• Marymount Medical Center Physician Services (MMC Physician Services)
• Marymount Medical Center Physician Services (Pulmonary & Sleep Specialists of London)
• Marymount Medical Center Physician Services
• Marymount Medical Center Physician Services
• Antwon Mason, LMT
• Amanda Baker Mastin, PHARMD

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in London, KY
• Providers in London, KY by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.