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1194774760

NPI Code Detail

MEDICARE: TYSON, SCHWAB, SHORT & WEISS PSC

MEDICARE: TYSON, SCHWAB, SHORT & WEISS PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner
2	2085R0202X	Diagnostic Radiology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	CD0227	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000000063366	OTHER	KY	ANTHEM BLUE FACET
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194774760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TYSON, SCHWAB, SHORT & WEISS PSC

Provider Business Mailing Address
First Line	:	222 S 1ST ST
Second Line	:	SUITE 501
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-5404
Country	:	US
Telephone Number	:	502-583-2731
Fax Number	:	502-583-2733

Provider Business Practice Location Address
First Line	:	200 ABRAHAM FLEXNER WAY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-1818
Country	:	US
Telephone Number	:	502-587-4231
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/RADIOLOGIST
Name	:	DEAN LESLIE
Credential	:	M.D.
Telephone Number	:	502-583-2731

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	03/12/2018

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Directions to “TYSON, SCHWAB, SHORT & WEISS PSC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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