1629075825 NPI number — UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION, INC

Table of content: (NPI 1629075825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629075825 NPI number — UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KIDNEY DISEASE PROGRAM / LOUISVILLE RENAL DIALYSIS FACILITY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629075825
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
615 S PRESTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40202-1715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-852-5757
Provider Business Mailing Address Fax Number:
502-852-4039

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 S PRESTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-1715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-852-5757
Provider Business Practice Location Address Fax Number:
502-852-4039
Provider Enumeration Date:
07/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LEDERER
Authorized Official First Name:
ELEANOR
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CHIEF, DIVISION OF NEPHROLOGY
Authorized Official Telephone Number:
502-852-5757

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  182501 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100003040A . This is a "INDIANA MEDICAID" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 39090030 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000003108H . This is a "HUMANA HEALTH CARE NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 004541476 . This is a "AETNA PROVIDER #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50001023 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5416V4981 . This is a "AHDS PROVIDER #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000112462 . This is a "BCBS 12 DIGIT PROVIDER #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 350 . This is a "BLUE CROSS NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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