MEDICARE: LOUISVILLE PALLIATIVE CARE LLC

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	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	25867	KY

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

General Provider Information

NPI Number	:	1346472750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUISVILLE PALLIATIVE CARE LLC

Provider Business Mailing Address
First Line	:	5644 RELIABLE PARKWAY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60686-0056
Country	:	US
Telephone Number	:	502-262-5172
Fax Number	:	502-244-6249

Provider Business Practice Location Address
First Line	:	3625 FERN VALLEY ROAD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40219-1916
Country	:	US
Telephone Number	:	502-262-5172
Fax Number	:	502-244-6249

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JANE E CORNETT
Credential	:	MD
Telephone Number	:	502-262-5172

Provider Enumeration Date	:	08/18/2009
Last Update Date	:	08/31/2017

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