NPIMap

Organization Active NPI

Christian Cardiology Internal Medicine

  • Medical Specialty Clinic/Center
  • Manchester, KY
National Provider Identifier
1801970439
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
Legal business name
CHRISTIAN CARDIOLOGY INTERNAL MEDICINE
Practice address
113 Main St
Manchester, KY 40962-1258
Phone
(606) 598-5807
NPI assigned
Oct 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Miss Teresa Collatz, CEO
Title
Administrator
Phone
(606) 598-5807

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X Primary

Addresses

Primary practice location

113 Main St
Manchester, KY 40962-1258

Mailing address

113 Main St
PO Box 159
Manchester, KY 40962-1258
Phone (606) 598-5807

Other identifiers 1

IdentifierTypeStateIssuer
65930133MedicaidKY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801970439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 MAIN ST",
            "address_2": "PO BOX 159",
            "city": "MANCHESTER",
            "state": "KY",
            "postal_code": "409621258",
            "telephone_number": "606-598-5807",
            "fax_number": "606-599-8898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 MAIN ST",
            "city": "MANCHESTER",
            "state": "KY",
            "postal_code": "409621258",
            "telephone_number": "606-598-5807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTIAN CARDIOLOGY INTERNAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COLLATZ",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "606-598-5807",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65930133",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, KY

Sources for this page

  • 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.