Provider Demographics
NPI:1043216393
Name:HOUSE, KENNETH WAYNE (DO)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:WAYNE
Last Name:HOUSE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HEART AND VASCULAR CENTER
Mailing Address - Street 2:605 SHARON RD.
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009
Mailing Address - Country:US
Mailing Address - Phone:724-773-4502
Mailing Address - Fax:724-770-7906
Practice Address - Street 1:HEART AND VASCULAR CENTER
Practice Address - Street 2:605 SHARON RD.
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009
Practice Address - Country:US
Practice Address - Phone:724-773-4502
Practice Address - Fax:724-770-7906
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007859207RI0011X
PAOS007312E207RI0011X, 207RC0000X
OH34007859H207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01393216Medicaid
PA727848Medicare PIN
PA01393216Medicaid