MEDICARE: LOUISVILLE PULMONARY ASSOCIATES, 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	174400000X	Specialist	22609	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CM5707	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	2432231000	OTHER		PASSPORT ADVANTAGE

General Provider Information

NPI Number	:	1336111376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUISVILLE PULMONARY ASSOCIATES, PSC

Provider Business Mailing Address
First Line	:	4402 CHURCHMAN AVE
Second Line	:	SUITE 305
City	:	LOUISVILLE
State	:	KY
Zip	:	40215-1190
Country	:	US
Telephone Number	:	502-368-9590
Fax Number	:	502-368-9616

Provider Business Practice Location Address
First Line	:	4402 CHURCHMAN AVE
Second Line	:	SUITE 305
City	:	LOUISVILLE
State	:	KY
Zip	:	40215-1190
Country	:	US
Telephone Number	:	502-368-9590
Fax Number	:	502-368-9616

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MRS. STACY LOUISE RALSTON
Credential	:	CCPC, LMR
Telephone Number	:	502-368-9590

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	10/09/2007

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Directions to “LOUISVILLE PULMONARY ASSOCIATES, PSC ” Practice Location

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