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NPI Code Detail

MEDICARE: UNIVERSITY PEDIATRICS FOUNDATION, INC.

MEDICARE: UNIVERSITY PEDIATRICS 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
1208000000XPediatrics Physician
22080A0000XPediatric Adolescent Medicine Physician
3311Z00000XCustodial Care Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376716688
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNIVERSITY PEDIATRICS FOUNDATION, INC.
Provider Business Mailing Address
First Line : PO BOX 2469
Second Line :
City : LOUISVILLE
State : KY
Zip : 40201-2469
Country : US
Telephone Number : 502-852-8500
Fax Number : 502-852-8556
Provider Business Practice Location Address
First Line : 1015 DORSEY LN
Second Line :
City : LOUISVILLE
State : KY
Zip : 40223-2612
Country : US
Telephone Number : 502-852-8500
Fax Number : 502-852-8556
Authorized Official
Title or Position : CHAIRMAN
Name : DR. GERARD P. RABALAIS
Credential : M.D.
Telephone Number : 502-852-8600
Provider Enumeration Date : 04/08/2008
Last Update Date : 06/17/2008

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Directions to “UNIVERSITY PEDIATRICS FOUNDATION, INC. ” Practice Location

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