1902862857 NPI number — UNIVERSITY PHYSICIAN ASSOCIATES

Table of content: (NPI 1902862857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902862857 NPI number — UNIVERSITY PHYSICIAN ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY PHYSICIAN ASSOCIATES
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:
U OF L FAMILY MEDICINE GERIATRICS
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:
1902862857
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 E BROADWAY
Provider Second Line Business Mailing Address:
STE 120
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-562-6783
Provider Business Mailing Address Fax Number:
502-562-6777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 CENTRAL AVE
Provider Second Line Business Practice Location Address:
102
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-852-7449
Provider Business Practice Location Address Fax Number:
502-852-1423
Provider Enumeration Date:
04/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOVE
Authorized Official First Name:
BELINDA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
502-562-6783

Provider Taxonomy Codes

  • Taxonomy code: 207QG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 31000102 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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