1700842036 NPI number — UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION

Table of content: (NPI 1700842036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700842036 NPI number — UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION
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:
1700842036
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2011
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:
SUITE 290
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40202-1785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-217-8221
Provider Business Mailing Address Fax Number:
502-217-5056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 CENTRAL AVE
Provider Second Line Business Practice Location Address:
100
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40208-1449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-852-2822
Provider Business Practice Location Address Fax Number:
502-852-2819
Provider Enumeration Date:
04/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OBRIEN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
CHARIMAN OF DEPARTMENT
Authorized Official Telephone Number:
502-852-5498

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1051450 . This is a "PASSPORT HEALTH PLAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200255880 A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65900474 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 78905379 -APRN , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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