Healthcare Provider Details

I. General information

NPI: 1477721801
Provider Name (Legal Business Name): PRESTON STATION OCCUPATIONAL HEALTH SERVICES, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 BISHOP LN STE 205
LOUISVILLE KY
40218-1973
US

IV. Provider business mailing address

1941 BISHOP LN STE 205
LOUISVILLE KY
40218-1973
US

V. Phone/Fax

Practice location:
  • Phone: 502-375-3242
  • Fax: 502-375-4331
Mailing address:
  • Phone: 502-499-2197
  • Fax: 502-499-2198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number02528
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3005276
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02528
License Number StateKY

VIII. Authorized Official

Name: DR. PETER URDA
Title or Position: PRESIDENT
Credential: D.O.
Phone: 502-375-3242