MEDICARE: LOUISVILLE PRIMARY CARE

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1306341417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUISVILLE PRIMARY CARE

Provider Business Mailing Address
First Line	:	801 BARRET AVE STE 112
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40204-1732
Country	:	US
Telephone Number	:	502-200-8259
Fax Number	:	502-584-8379

Provider Business Practice Location Address
First Line	:	801 BARRET AVE STE 112
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40204-1732
Country	:	US
Telephone Number	:	502-200-8259
Fax Number	:	502-584-8379

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	JULIE SCHOENBAECHLER
Credential	:
Telephone Number	:	502-220-8437

Provider Enumeration Date	:	03/29/2018
Last Update Date	:	04/27/2018

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Directions to “LOUISVILLE PRIMARY CARE ” Practice Location

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