MEDICARE: TOMMY L LOUISVILLE MD PA

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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1508012477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOMMY L LOUISVILLE MD PA

Provider Business Mailing Address
First Line	:	1598 US 27 N
Second Line	:
City	:	AVON PARK
State	:	FL
Zip	:	33825-2151
Country	:	US
Telephone Number	:	863-452-1980
Fax Number	:	407-386-3342

Provider Business Practice Location Address
First Line	:	1598 US 27 N
Second Line	:
City	:	AVON PARK
State	:	FL
Zip	:	33825-2151
Country	:	US
Telephone Number	:	863-452-1980
Fax Number	:	407-386-3342

Authorized Official
Title or Position	:	CEO
Name	:	TOMMY L LOUISVILLE
Credential	:	MD
Telephone Number	:	863-452-1980

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	08/12/2008

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