Provider Demographics
NPI:1053456004
Name:LOUISVILLE-JEFFERSON COUNTY METRO GOVERNMENT
Entity Type:Organization
Organization Name:LOUISVILLE-JEFFERSON COUNTY METRO GOVERNMENT
Other - Org Name:LOUISVILLE METRO DEPARTMENT OF PUBLIC HEALTH AND WELLNESS - NP -TJ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER II
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:KRING
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:502-574-8430
Mailing Address - Street 1:400 E GRAY ST
Mailing Address - Street 2:P.O BOX 1704
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1740
Mailing Address - Country:US
Mailing Address - Phone:502-574-5652
Mailing Address - Fax:502-574-6417
Practice Address - Street 1:4401 RANGELAND RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-5409
Practice Address - Country:US
Practice Address - Phone:502-962-3174
Practice Address - Fax:502-962-3171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251K00000X251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20056222Medicaid
KY1060993OtherPASSPORT MANAGED CARE NUM
KY20056222Medicaid