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General NPI Number Information
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NPI Number | 1265604763
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Entity Type | Organization
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Legal Business Name | LOUISVILLE PATIENT CENTERED MEDICAL HOME, PSC
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Dates
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Enumeration Date | 03/25/2008
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Last Update Date | 12/27/2013
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Provider Practice Location Address
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Address Line | 4010 DUPONT CIR SUITE 308
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City | LOUISVILLE
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State | KY
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Zip | 40207-4812
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Country | US
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Telephone | 502-896-8041
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Fax | 502-896-8044
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Provider Business Mailing Address
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Address Line | 4010 DUPONT CIR SUITE 308
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City | LOUISVILLE
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State | KY
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Zip | 40207-4812
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Country | US
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Telephone | 502-896-8041
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Fax | 502-896-8044
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. JAMES D. CHARASIKA
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Credential | M.D.
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Telephone | 502-896-8041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 18988
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 18988
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License Number State | KY
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