Healthcare Provider Details

I. General information

NPI: 1316072960
Provider Name (Legal Business Name): LOUISVILLE-JEFFERSON COUNTY METRO GOVERNMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 04/22/2024
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NEIGHBORHOOD PL
FAIRDALE KY
40118-9697
US

IV. Provider business mailing address

400 E GRAY ST P.O. BOX 1704
LOUISVILLE KY
40202-1740
US

V. Phone/Fax

Practice location:
  • Phone: 502-363-1428
  • Fax: 502-363-1463
Mailing address:
  • Phone: 502-574-6514
  • Fax: 502-574-6417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number251K00004
License Number StateKY

VIII. Authorized Official

Name: MS. ROBYN M DICKERSON
Title or Position: FISCAL MANAGER
Credential: MSM
Phone: 502-574-6580