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General NPI Number Information
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NPI Number | 1164293908
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Entity Type | Organization
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Legal Business Name | PEDIATRICS OF BULLITT COUNTY PLLC
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Dates
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Enumeration Date | 01/10/2024
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 1707 CEDAR GROVE RD STE 20
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City | SHEPHERDSVILLE
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State | KY
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Zip | 40165-8592
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Country | US
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Telephone | 502-215-5090
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Fax | 502-215-5095
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Provider Business Mailing Address
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Address Line | 327 EASTBROOKE POINTE DR STE 200
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City | MOUNT WASHINGTON
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State | KY
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Zip | 40047-5577
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Country | US
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Telephone | 502-538-5090
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | CASEY MILES LEWIS
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Credential | MD
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Telephone | 502-538-5090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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