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General NPI Number Information
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NPI Number | 1932524386
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Entity Type | Organization
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Legal Business Name | LOUISVILLE VASCULAR CARE LLC
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Dates
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Enumeration Date | 02/21/2014
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 645 S ROY WILKINS AVE
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City | LOUISVILLE
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State | KY
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Zip | 40203-2072
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Country | US
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Telephone | 502-208-1036
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Fax |
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Provider Business Mailing Address
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Address Line | 9140 CORSEA DEL FONTANA WAY
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City | NAPLES
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State | FL
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Zip | 34109-4397
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | LISA MCNAMARA
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Credential |
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Telephone | 239-597-2010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology 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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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