Healthcare Provider Details

I. General information

NPI: 1114000478
Provider Name (Legal Business Name): VAACA OF KENTUCKY PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 GOSS AVE
LOUISVILLE KY
40217-1239
US

IV. Provider business mailing address

1261 GOSS AVE
LOUISVILLE KY
40217-1239
US

V. Phone/Fax

Practice location:
  • Phone: 502-635-6937
  • Fax: 502-634-3926
Mailing address:
  • Phone: 502-635-6937
  • Fax: 502-634-3926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. BECKY LEE NOAH
Title or Position: PRACTICE ADMINISTRATOR
Credential: CMM
Phone: 502-635-6937