Healthcare Provider Details

I. General information

NPI: 1487766010
Provider Name (Legal Business Name): LAGRANGE FAMILY CARE DOCTORS P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 PARKER PL SUITE 200
LA GRANGE KY
40031-2223
US

IV. Provider business mailing address

501 PARKER PL SUITE 200
LA GRANGE KY
40031-2223
US

V. Phone/Fax

Practice location:
  • Phone: 502-222-7144
  • Fax: 502-222-2034
Mailing address:
  • Phone: 502-222-7144
  • Fax: 502-222-2034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. PLAVAKEERTHI KEMPARAJURS
Title or Position: M.D./OWNER
Credential: M.D.
Phone: 502-222-7144