Healthcare Provider Details

I. General information

NPI: 1285617886
Provider Name (Legal Business Name): LOUISVILLE PEDIATRIC SPECIALISTS,PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 DIXIE HWY SUITE127
LOUISVILLE KY
40258-3913
US

IV. Provider business mailing address

6801 DIXIE HWY SUITE127
LOUISVILLE KY
40258-3913
US

V. Phone/Fax

Practice location:
  • Phone: 502-935-5633
  • Fax: 502-935-5706
Mailing address:
  • Phone: 502-935-5633
  • Fax: 502-935-5706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TRUDI L RASH
Title or Position: SECRETARY/OWNER
Credential: M.D.
Phone: 502-935-5633