Provider Demographics
NPI:1083851257
Name:LOUISVILLE & SO INDIANA PULMONARY CARE PLC
Entity Type:Organization
Organization Name:LOUISVILLE & SO INDIANA PULMONARY CARE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KILLEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-368-9590
Mailing Address - Street 1:4402 CHURCHMAN AVE
Mailing Address - Street 2:SUITE 409
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1190
Mailing Address - Country:US
Mailing Address - Phone:502-368-9590
Mailing Address - Fax:502-368-9616
Practice Address - Street 1:4402 CHURCHMAN AVE
Practice Address - Street 2:SUITE 409
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1190
Practice Address - Country:US
Practice Address - Phone:502-368-9590
Practice Address - Fax:502-368-9616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200926940AMedicaid
KY000000701204OtherANTHEM
DR3113OtherRAILROAD MEDICARE
KY7100144810Medicaid
DR3113OtherRAILROAD MEDICARE