Healthcare Provider Details

I. General information

NPI: 1699767327
Provider Name (Legal Business Name): MEDICAL CENTER INTERNISTS, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 ABRAHAM FLEXNER WAY SUITE 304
LOUISVILLE KY
40202-1846
US

IV. Provider business mailing address

225 ABRAHAM FLEXNER WAY SUITE 304
LOUISVILLE KY
40202-1846
US

V. Phone/Fax

Practice location:
  • Phone: 502-585-1200
  • Fax: 502-585-1207
Mailing address:
  • Phone: 502-585-1200
  • Fax: 502-585-1207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24559 25176 32796
License Number StateKY

VIII. Authorized Official

Name: DR. KEITH B CARTER
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 502-585-1200