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General NPI Number Information
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NPI Number | 1184805160
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Entity Type | Organization
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Legal Business Name | SIMPLISTIC URGENT CARE, PLLC
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 11/19/2007
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Provider Practice Location Address
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Address Line | 915 BAXTER AVE
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City | LOUISVILLE
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State | KY
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Zip | 40204-2046
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Country | US
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Telephone | 502-479-3245
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Fax | 502-479-3066
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Provider Business Mailing Address
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Address Line | 915 BAXTER AVE
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City | LOUISVILLE
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State | KY
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Zip | 40204-2046
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Country | US
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Telephone | 502-479-3245
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Fax | 502-479-3066
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Authorized Official
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Title or Position | MEMBER
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Name | REBECCA J SUTTON
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Credential | MD
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Telephone | 502-479-3245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 34205
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 34205
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License Number State | KY
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