MEDICARE: UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION, INC

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	291U00000X	Clinical Medical Laboratory	200145	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000001555J	OTHER	KY	HUMANA PROV #
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	50A8	OTHER	KY	BLUE CROSS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	3580095	OTHER	KY	UNITED HEALTH CARE PROV #
7	000000070124	OTHER	KY	BCBS(NEWER POLICIES)
8	5416V4981	OTHER	KY	HEALTHCARE PREFERRED PROV

General Provider Information

NPI Number	:	1346247111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION, INC

Provider Business Mailing Address
First Line	:	500 S PRESTON ST
Second Line	:	ROOM 126, BLDG 55B
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-1702
Country	:	US
Telephone Number	:	502-852-5865
Fax Number	:	502-852-5782

Provider Business Practice Location Address
First Line	:	500 S PRESTON ST
Second Line	:	ROOM 126, BLDG 55B
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-1702
Country	:	US
Telephone Number	:	502-852-5865
Fax Number	:	502-852-5782

Authorized Official
Title or Position	:	LABORATORY DIRECTOR
Name	:	DR. JON BERNARD KLEIN
Credential	:	M.D.
Telephone Number	:	502-852-5865

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	11/02/2015

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