Healthcare Provider Details

I. General information

NPI: 1144467770
Provider Name (Legal Business Name): CENTRAL STATE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10510 LA GRANGE RD
LOUISVILLE KY
40223-1277
US

IV. Provider business mailing address

10510 LA GRANGE RD
LOUISVILLE KY
40223-1277
US

V. Phone/Fax

Practice location:
  • Phone: 502-253-7337
  • Fax: 502-253-7344
Mailing address:
  • Phone: 502-253-7337
  • Fax: 502-253-7344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberP05065
License Number StateKY

VIII. Authorized Official

Name: JOE MCCULLEN
Title or Position: SENIOR CONTROLLER
Credential:
Phone: 502-253-7000