1346247111 NPI number — UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION, INC

Table of content: (NPI 1346247111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346247111 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:
RENAL TRANSPLANT LABORATORY
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:
1346247111
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 S PRESTON ST
Provider Second Line Business Mailing Address:
ROOM 126, BLDG 55B
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40202-1702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-852-5865
Provider Business Mailing Address Fax Number:
502-852-5782

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 S PRESTON ST
Provider Second Line Business Practice Location Address:
ROOM 126, BLDG 55B
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-852-5865
Provider Business Practice Location Address Fax Number:
502-852-5782
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KLEIN
Authorized Official First Name:
JON
Authorized Official Middle Name:
BERNARD
Authorized Official Title or Position:
LABORATORY DIRECTOR
Authorized Official Telephone Number:
502-852-5865

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  200145 , 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: 000001555J . This is a "HUMANA PROV #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 37902442 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1058952 VEN# 1058830 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50A8 . This is a "BLUE CROSS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200073430A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3580095 . This is a "UNITED HEALTH CARE PROV #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000070124 . This is a "BCBS(NEWER POLICIES)" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 5416V4981 . This is a "HEALTHCARE PREFERRED PROV" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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