Healthcare Provider Details

I. General information

NPI: 1730326109
Provider Name (Legal Business Name): PEDIATRICS OF BULLITT COUNTY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 CEDAR GROVE RD SUITE 20
SHEPHERDSVILLE KY
40165-8572
US

IV. Provider business mailing address

1707 CEDAR GROVE RD SUITE 20
SHEPHERDSVILLE KY
40165-8572
US

V. Phone/Fax

Practice location:
  • Phone: 502-215-5090
  • Fax: 502-215-2095
Mailing address:
  • Phone: 502-215-5090
  • Fax: 502-215-2095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CASEY M LEWIS
Title or Position: OWNER
Credential: MD
Phone: 502-215-5090