1841564291 NPI number — LOUISVILLE LUNG CARE PLLC

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 1841564291 NPI number — LOUISVILLE LUNG CARE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOUISVILLE LUNG CARE PLLC
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:
1841564291
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 22225
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:
40252-0225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-691-2223
Provider Business Mailing Address Fax Number:
502-410-0484

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1015 DUPONT RD
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:
40207-4610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-883-0227
Provider Business Practice Location Address Fax Number:
502-410-0484
Provider Enumeration Date:
03/02/2012

Additional Information

Authorized Official

Authorized Official Last Name:
AL-NABHAN
Authorized Official First Name:
MOUTAZ
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE MBR
Authorized Official Telephone Number:
918-691-2223

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  42043 , 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: 7100142140 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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