Healthcare Provider Details

I. General information

NPI: 1942230578
Provider Name (Legal Business Name): A BERT SPARROW PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 CHURCHMAN AVE STE 211
LOUISVILLE KY
40215-3100
US

IV. Provider business mailing address

4402 CHURCHMAN AVE STE 211
LOUISVILLE KY
40215-3100
US

V. Phone/Fax

Practice location:
  • Phone: 502-361-6075
  • Fax: 502-361-6071
Mailing address:
  • Phone: 502-361-6075
  • Fax: 502-361-6071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number13980
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number13980
License Number StateKY

VIII. Authorized Official

Name: DR. ATHEL BERT SPARROW
Title or Position: PRESIDENT
Credential: M.D.
Phone: 502-361-6075