Healthcare Provider Details

I. General information

NPI: 1841339710
Provider Name (Legal Business Name): BONE MARROW TRANSPLANT, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S FLOYD ST SUITE 403
LOUISVILLE KY
40202-1835
US

IV. Provider business mailing address

601 S FLOYD ST SUITE 403
LOUISVILLE KY
40202-1835
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-7750
  • Fax: 502-629-7784
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SALVATORE JAMES BERTOLONE JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 502-629-7750