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General NPI Number Information
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NPI Number | 1982360483
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Entity Type | Organization
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Legal Business Name | INTERLOCKING HEARTS HEALTHCARE - PRIMARY AND EXPRESS CARE
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Dates
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Enumeration Date | 11/10/2021
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 3438 TAYLOR BLVD
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City | LOUISVILLE
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State | KY
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Zip | 40215-2648
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Country | US
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Telephone | 502-365-2340
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Fax | 502-365-3063
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Provider Business Mailing Address
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Address Line | 3438 TAYLOR BLVD
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City | LOUISVILLE
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State | KY
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Zip | 40215-2648
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Country | US
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Telephone | 502-365-2340
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Fax | 502-365-3063
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | OMEGA SAVAGE
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Credential | APRN
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Telephone | 502-821-0652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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