Healthcare Provider Details

I. General information

NPI: 1881932028
Provider Name (Legal Business Name): JEFFERSONTOWN MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 04/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10131 TAYLORSVILLE RD
JEFFERSONTOWN KY
40299-3649
US

IV. Provider business mailing address

10131 TAYLORSVILLE RD
JEFFERSONTOWN KY
40299-3649
US

V. Phone/Fax

Practice location:
  • Phone: 502-267-6444
  • Fax: 502-267-6445
Mailing address:
  • Phone: 502-267-6444
  • Fax: 502-267-6445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number43136
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA758
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number43136
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number43136
License Number StateKY

VIII. Authorized Official

Name: NEIL P LANGSCHIED
Title or Position: PRESIDENT
Credential: DC
Phone: 502-267-6444