Provider Demographics
NPI:1063470755
Name:BEDSIDE MEDICINE, PLLC
Entity Type:Organization
Organization Name:BEDSIDE MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER AND PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:DONNELLY
Authorized Official - Last Name:SPALDING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-618-0476
Mailing Address - Street 1:6102 BAYLOR CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-6147
Mailing Address - Country:US
Mailing Address - Phone:502-618-0476
Mailing Address - Fax:
Practice Address - Street 1:6102 BAYLOR CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-6147
Practice Address - Country:US
Practice Address - Phone:502-618-0476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY373233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYH81323Medicare UPIN