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General NPI Number Information
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NPI Number | 1699380436
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Entity Type | Organization
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Legal Business Name | COMMUNITY MEDICAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 09/09/2020
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Last Update Date | 09/21/2021
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Provider Practice Location Address
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Address Line | 4803 OLYMPIA PARK PLZ STE 1100
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City | LOUISVILLE
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State | KY
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Zip | 40241-3068
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Country | US
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Telephone | 502-588-9490
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Fax | 502-272-5339
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Provider Business Mailing Address
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Address Line | PO BOX 776351
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City | CHICAGO
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State | IL
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Zip | 60677-6351
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Country | US
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Telephone | 502-588-9490
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Fax | 502-272-5339
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Authorized Official
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Title or Position | SYST VP MNGD CARE & PAYOR STRAT
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Name | SHELLEY GAST
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Credential |
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Telephone | 502-272-5335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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