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General NPI Number Information
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NPI Number | 1609269414
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Entity Type | Organization
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Legal Business Name | PRESTON MEDICAL CENTER
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 03/18/2015
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Provider Practice Location Address
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Address Line | 927 S 3RD ST
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City | LOUISVILLE
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State | KY
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Zip | 40203-2215
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Country | US
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Telephone | 502-614-2824
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Fax |
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Provider Business Mailing Address
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Address Line | 927 S 3RD ST
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City | LOUISVILLE
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State | KY
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Zip | 40203-2215
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Country | US
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Telephone | 502-614-2824
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DAVID WEBER
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Credential | MD
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Telephone | 502-614-2824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35882
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License Number State | KY
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