MEDICARE: U.S. HEALTHWORKS MEDICAL GROUP OF KENTUCKY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083X0100X	Occupational Medicine Physician

General Provider Information

NPI Number	:	1730638750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	U.S. HEALTHWORKS MEDICAL GROUP OF KENTUCKY, INC.

Provider Business Mailing Address
First Line	:	25124 SPRINGFIELD CT
Second Line	:	200
City	:	VALENCIA
State	:	CA
Zip	:	91355-1085
Country	:	US
Telephone Number	:	661-678-2600
Fax Number	:	661-678-2700

Provider Business Practice Location Address
First Line	:	100 HIGH RISE DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40213-3251
Country	:	US
Telephone Number	:	502-964-3688
Fax Number	:	502-968-7146

Authorized Official
Title or Position	:	PRESIDENT & CHEIF EXECTUTIVE OFFICE
Name	:	MR. JOSEPH T MALLAS
Credential	:
Telephone Number	:	661-678-2600

Provider Enumeration Date	:	10/03/2016
Last Update Date	:	10/03/2016

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