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General NPI Number Information
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NPI Number | 1942230578
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Entity Type | Organization
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Legal Business Name | A BERT SPARROW PSC
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 4402 CHURCHMAN AVE STE 211
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City | LOUISVILLE
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State | KY
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Zip | 40215-3100
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Country | US
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Telephone | 502-361-6075
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Fax | 502-361-6071
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Provider Business Mailing Address
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Address Line | 4402 CHURCHMAN AVE STE 211
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City | LOUISVILLE
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State | KY
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Zip | 40215-3100
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Country | US
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Telephone | 502-361-6075
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Fax | 502-361-6071
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ATHEL BERT SPARROW
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Credential | M.D.
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Telephone | 502-361-6075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 13980
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 13980
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License Number State | KY
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