Healthcare Provider Details

I. General information

NPI: 1063033892
Provider Name (Legal Business Name): EMMA ROSE GANSHIRT FOX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ABRAHAM FLEXNER WAY
LOUISVILLE KY
40202-2877
US

IV. Provider business mailing address

PO BOX 909
LOUISVILLE KY
40201-0909
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-5689
  • Fax:
Mailing address:
  • Phone: 502-588-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number60047
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number60047
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: