Healthcare Provider Details

I. General information

NPI: 1538153309
Provider Name (Legal Business Name): ST MATTHEWS MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4003 KRESGE WAY SUITE 400
LOUISVILLE KY
40207-4652
US

IV. Provider business mailing address

4003 KRESGE WAY SUITE 400
LOUISVILLE KY
40207-4652
US

V. Phone/Fax

Practice location:
  • Phone: 502-895-4263
  • Fax: 502-899-5488
Mailing address:
  • Phone: 502-895-4263
  • Fax: 502-899-5488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number18D0321241
License Number StateKY

VIII. Authorized Official

Name: DR. LAWRENCE J RUEFF
Title or Position: PARTNER
Credential: M.D.
Phone: 502-895-4263