Healthcare Provider Details

I. General information

NPI: 1285297879
Provider Name (Legal Business Name): MITCHELL LEE MEFFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S PRESTON ST RM 305
LOUISVILLE KY
40202-1702
US

IV. Provider business mailing address

500 S PRESTON ST RM 305
LOUISVILLE KY
40202-1702
US

V. Phone/Fax

Practice location:
  • Phone: 502-892-8696
  • Fax:
Mailing address:
  • Phone: 502-892-8696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: