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NPI Code Detail

MEDICARE: UNIVERSITY OF LOUISVILLE PHYSICIANS, INC.

MEDICARE: UNIVERSITY OF LOUISVILLE PHYSICIANS, 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

General Provider Information

NPI Number : 1487910105
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNIVERSITY OF LOUISVILLE PHYSICIANS, INC.
Provider Business Mailing Address
First Line : PO BOX 909
Second Line :
City : LOUISVILLE
State : KY
Zip : 40201-0909
Country : US
Telephone Number : 502-588-0320
Fax Number : 502-588-0326
Provider Business Practice Location Address
First Line : 230 E BROADWAY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40202-2008
Country : US
Telephone Number : 502-629-8901
Fax Number : 502-629-7065
Authorized Official
Title or Position : VP OF HUMAN RESOURCES
Name : JOHN ELLIOTT
Credential :
Telephone Number : 502-588-4206
Provider Enumeration Date : 04/06/2012
Last Update Date : 04/06/2012

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