Healthcare Provider Details

I. General information

NPI: 1669858619
Provider Name (Legal Business Name): PRIVATUS MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 RUNNYMEDE RD
LOUISVILLE KY
40222-6144
US

IV. Provider business mailing address

3120 RUNNYMEDE RD
LOUISVILLE KY
40222-6144
US

V. Phone/Fax

Practice location:
  • Phone: 502-657-1076
  • Fax: 888-959-2460
Mailing address:
  • Phone: 502-657-1076
  • Fax: 888-959-2460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. PAT CURRY
Title or Position: OWNER
Credential:
Phone: 502-905-2183