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NPI Code Detail

MEDICARE: PRESTON STATION OCCUPATIONAL HEALTH SERVICES, PSC

MEDICARE: PRESTON STATION OCCUPATIONAL HEALTH SERVICES, 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
12083X0100XOccupational Medicine Physician02528KY
2363LF0000XFamily Nurse Practitioner3005276KY
3207Q00000XFamily Medicine Physician02528KY

General Provider Information

NPI Number : 1477721801
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRESTON STATION OCCUPATIONAL HEALTH SERVICES, PSC
Provider Business Mailing Address
First Line : 1941 BISHOP LN STE 205
Second Line :
City : LOUISVILLE
State : KY
Zip : 40218-1973
Country : US
Telephone Number : 502-499-2197
Fax Number : 502-499-2198
Provider Business Practice Location Address
First Line : 1941 BISHOP LN STE 205
Second Line :
City : LOUISVILLE
State : KY
Zip : 40218-1973
Country : US
Telephone Number : 502-375-3242
Fax Number : 502-375-4331
Authorized Official
Title or Position : PRESIDENT
Name : DR. PETER URDA
Credential : D.O.
Telephone Number : 502-375-3242
Provider Enumeration Date : 02/19/2008
Last Update Date : 03/07/2011

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Directions to “PRESTON STATION OCCUPATIONAL HEALTH SERVICES, PSC ” Practice Location

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