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General NPI Number Information
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NPI Number | 1164614368
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Entity Type | Organization
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Legal Business Name | IROQUOIS MEDICAL CENTER,P.S.C.
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 1905 W HEBRON LN SUITE 103
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City | SHEPHERDSVILLE
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State | KY
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Zip | 40165-7465
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Country | US
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Telephone | 502-957-7580
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Fax | 502-957-6667
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Provider Business Mailing Address
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Address Line | 5601 S 3RD ST 100
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City | LOUISVILLE
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State | KY
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Zip | 40214-2615
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Country | US
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Telephone | 502-366-7720
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Fax | 502-366-0824
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MRS. NEVA ALLEN
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Credential |
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Telephone | 502-366-7720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34540
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License Number State | KY
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