Provider Demographics
NPI:1043484652
Name:UNIVERSITY FAMILY & GERIATRIC MEDICINE ASSOCIATES INC
Entity Type:Organization
Organization Name:UNIVERSITY FAMILY & GERIATRIC MEDICINE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPARTMENT CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-852-8498
Mailing Address - Street 1:501 E BROADWAY
Mailing Address - Street 2:STE 240
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1785
Mailing Address - Country:US
Mailing Address - Phone:502-852-2501
Mailing Address - Fax:502-852-0651
Practice Address - Street 1:215 CENTRAL AVE
Practice Address - Street 2:STE 102
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-1418
Practice Address - Country:US
Practice Address - Phone:502-852-7449
Practice Address - Fax:502-852-1423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100039550Medicaid
KY00694Medicare PIN