Healthcare Provider Details

I. General information

NPI: 1720212194
Provider Name (Legal Business Name): BETHANY COX SNIDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 DUTCHMANS LN
LOUISVILLE KY
40205-3271
US

IV. Provider business mailing address

6200 DUTCHMANS LN
LOUISVILLE KY
40205-3271
US

V. Phone/Fax

Practice location:
  • Phone: 502-456-6200
  • Fax:
Mailing address:
  • Phone: 502-456-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number44655
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01072780A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number01072780A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number44655
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: