Provider Demographics
NPI:1114064912
Name:U OF L RESEARCH FOUNDATION
Entity Type:Organization
Organization Name:U OF L RESEARCH FOUNDATION
Other - Org Name:UL FAM MED / NURSING HOMES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPARTMENT CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-562-6783
Mailing Address - Street 1:501 E BROADWAY
Mailing Address - Street 2:STE 120
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1785
Mailing Address - Country:US
Mailing Address - Phone:502-562-6783
Mailing Address - Fax:502-562-6777
Practice Address - Street 1:501 E BROADWAY
Practice Address - Street 2:STE 120
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1785
Practice Address - Country:US
Practice Address - Phone:502-562-6783
Practice Address - Fax:502-562-6777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY31000102Medicaid
KY2711Medicare PIN