Provider Demographics
NPI:1871545004
Name:PATIENT CHOICE CARDIOLOGY, P.S.C.
Entity type:Organization
Organization Name:PATIENT CHOICE CARDIOLOGY, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LIERL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-331-3353
Mailing Address - Street 1:L6099
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45270-6099
Mailing Address - Country:US
Mailing Address - Phone:859-331-3353
Mailing Address - Fax:859-331-3326
Practice Address - Street 1:20 MEDICAL VILLAGE DR
Practice Address - Street 2:STE. 177
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-5401
Practice Address - Country:US
Practice Address - Phone:859-331-3353
Practice Address - Fax:859-331-3326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYDE7424OtherRAILROAD MEDICARE
KY65944886Medicaid
KY65944886Medicaid
KYDE7424OtherRAILROAD MEDICARE