Provider Demographics
NPI:1033270434
Name:PEDIATRIC PULMONARY MEDICINE, PSC
Entity Type:Organization
Organization Name:PEDIATRIC PULMONARY MEDICINE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:NEMR
Authorized Official - Middle Name:
Authorized Official - Last Name:EID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-852-3772
Mailing Address - Street 1:6801 DIXIE HIGHWAY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258
Mailing Address - Country:US
Mailing Address - Phone:502-451-5855
Mailing Address - Fax:502-479-1409
Practice Address - Street 1:234 EAST GRAY STREET
Practice Address - Street 2:SUITE 270
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-852-3772
Practice Address - Fax:502-852-4051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY255742080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1050575OtherPASSPORT GROUP NUMBER
KY65921991Medicaid
KY1050575OtherPASSPORT GROUP NUMBER