Healthcare Provider Details

I. General information

NPI: 1588174593
Provider Name (Legal Business Name): DLS MEDICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 W BROADWAY STE 208
LOUISVILLE KY
40211-1370
US

IV. Provider business mailing address

3901 MEADOW RIDGE PL
LOUISVILLE KY
40218-3781
US

V. Phone/Fax

Practice location:
  • Phone: 502-802-5786
  • Fax:
Mailing address:
  • Phone: 502-802-5786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number3008696
License Number StateKY

VIII. Authorized Official

Name: DANA L SMITH
Title or Position: NURSE PRACTITIONER
Credential: APRN
Phone: 502-802-5786