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General NPI Number Information
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NPI Number | 1184663015
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Entity Type | Organization
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Legal Business Name | LOUISVILLE FAMILY & SPORTS MEDICINE PSC
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 03/28/2011
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Provider Practice Location Address
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Address Line | 9420 BROWNSBORO RD
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City | LOUISVILLE
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State | KY
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Zip | 40241-1118
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Country | US
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Telephone | 502-426-4264
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Fax | 402-426-4221
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Provider Business Mailing Address
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Address Line | 9420 BROWNSBORO RD
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City | LOUISVILLE
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State | KY
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Zip | 40241-1118
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Country | US
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Telephone | 502-426-4264
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Fax | 502-426-4221
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Authorized Official
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Title or Position | PRESIDENT
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Name | GREGORY V POTTS
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Credential | M.D.
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Telephone | 502-426-4264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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