1982630158 NPI number — EAST LOUISVILLE PATHOLOGISTS PSC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982630158 NPI number — EAST LOUISVILLE PATHOLOGISTS PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST LOUISVILLE PATHOLOGISTS PSC
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:
Provider Other Organization Name Type Code:
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:
1982630158
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1169 EASTERN PKWY
Provider Second Line Business Mailing Address:
SUITE G 71
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40217-1417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-456-6217
Provider Business Mailing Address Fax Number:
502-456-4440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 KRESGE WAY
Provider Second Line Business Practice Location Address:
PATHOLOGY DEPT
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-897-8226
Provider Business Practice Location Address Fax Number:
502-897-8215
Provider Enumeration Date:
06/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MATTHEWS
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
H
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
502-897-8226

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , 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: 000000063222 . This is a "ANTHEM BL CROSS BL SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0663153 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1049930 . This is a "MEDICAID PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1527296 . This is a "UNITED MINE WORKERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 124519600 . This is a "WORKERS COMP FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 104509 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200219150A . This is a "MEDICAID INDIANA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: CE9643 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1100181 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2432719000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 65929226 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".