1215100375 NPI number — UNIVERSITY PEDIATRICS FOUNDATION, INC.

Table of content: (NPI 1215100375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215100375 NPI number — UNIVERSITY PEDIATRICS FOUNDATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY PEDIATRICS 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:
Provider Other Organization Name Type Code:
6
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:
1215100375
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2469
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:
40201-2469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-852-8500
Provider Business Mailing Address Fax Number:
502-852-8556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 E BROADWAY
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:
40202-2008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-629-8901
Provider Business Practice Location Address Fax Number:
502-629-7065
Provider Enumeration Date:
04/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RABALAIS
Authorized Official First Name:
GERARD
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
CHAIRMAN DEPARTMENT OF PEDIATRICS
Authorized Official Telephone Number:
502-852-8600

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 65908238 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com