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General NPI Number Information
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NPI Number | 1295490613
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Entity Type | Organization
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Legal Business Name | APEX EMERGENTOLOGY LLC
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Dates
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Enumeration Date | 11/01/2021
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 1703 S 13TH ST
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City | LOUISVILLE
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State | KY
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Zip | 40210-2325
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Country | US
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Telephone | 615-567-5739
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Fax |
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Provider Business Mailing Address
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Address Line | 1703 S 13TH ST
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City | LOUISVILLE
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State | KY
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Zip | 40210-2325
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Country | US
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Telephone | 615-567-5739
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BENJAMIN DEHAVEN
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Credential |
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Telephone | 615-567-5739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State |
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