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General NPI Number Information
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NPI Number | 1588174593
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Entity Type | Organization
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Legal Business Name | DLS MEDICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 10/04/2017
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Last Update Date | 01/23/2018
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Provider Practice Location Address
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Address Line | 2600 W BROADWAY STE 208
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City | LOUISVILLE
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State | KY
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Zip | 40211-1370
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Country | US
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Telephone | 502-802-5786
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Fax |
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Provider Business Mailing Address
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Address Line | 3901 MEADOW RIDGE PL
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City | LOUISVILLE
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State | KY
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Zip | 40218-3781
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Country | US
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Telephone | 502-802-5786
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | DANA L SMITH
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Credential | APRN
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Telephone | 502-802-5786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 3008696
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License Number State | KY
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