Healthcare Provider Details

I. General information

NPI: 1285965087
Provider Name (Legal Business Name): PHYSICIANS PRACTICE MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2010
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6814 BROOK BEND WAY
LOUISVILLE KY
40229-2386
US

IV. Provider business mailing address

6814 BROOK BEND WAY
LOUISVILLE KY
40229-2386
US

V. Phone/Fax

Practice location:
  • Phone: 502-377-3016
  • Fax:
Mailing address:
  • Phone: 502-377-3016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number3607R
License Number StateKY

VIII. Authorized Official

Name: MR. STEVEN WAYNE LOWERY
Title or Position: OWNER
Credential:
Phone: 502-377-3016