Provider Demographics
NPI:1003974031
Name:NEUROSCIENCE ASSOCIATES, PSC
Entity Type:Organization
Organization Name:NEUROSCIENCE ASSOCIATES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:H
Authorized Official - Last Name:BIBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-895-7265
Mailing Address - Street 1:3900 KRESGE WAY
Mailing Address - Street 2:SUITE 56
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4660
Mailing Address - Country:US
Mailing Address - Phone:502-895-7265
Mailing Address - Fax:502-897-2113
Practice Address - Street 1:3 AUDUBON PLAZA DR
Practice Address - Street 2:SUITE 110
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1319
Practice Address - Country:US
Practice Address - Phone:502-634-3433
Practice Address - Fax:502-634-3494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5929OtherANTHEM
KY65904971Medicaid
CN0117OtherMEDICARE ID
KY1049098Medicaid
KY1049098Medicaid
OH========= 00OtherOHIO BUREAU OF WC
KY65904971Medicaid
CN0117OtherMEDICARE ID