Healthcare Provider Details

I. General information

NPI: 1184663015
Provider Name (Legal Business Name): LOUISVILLE FAMILY & SPORTS MEDICINE PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9420 BROWNSBORO RD
LOUISVILLE KY
40241-1118
US

IV. Provider business mailing address

9420 BROWNSBORO RD
LOUISVILLE KY
40241-1118
US

V. Phone/Fax

Practice location:
  • Phone: 502-426-4264
  • Fax: 402-426-4221
Mailing address:
  • Phone: 502-426-4264
  • Fax: 502-426-4221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGORY V POTTS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 502-426-4264