Healthcare Provider Details

I. General information

NPI: 1255466512
Provider Name (Legal Business Name): LOUISVILLE JEFFERSON COUNTY METRO GOVERNMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4810 EXETER AVE
LOUISVILLE KY
40218-3874
US

IV. Provider business mailing address

400 E GRAY ST P. O. BOX 1704
LOUISVILLE KY
40202-1740
US

V. Phone/Fax

Practice location:
  • Phone: 502-458-1215
  • Fax: 502-456-4812
Mailing address:
  • Phone: 502-574-6514
  • Fax: 502-574-6417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number251K000004
License Number StateKY

VIII. Authorized Official

Name: MS. ROBYN DICKERSON
Title or Position: FISCAL MANAGER
Credential: MSM
Phone: 502-574-6580