Provider Demographics
NPI:1114408747
Name:LOUISVILLE REPRODUCTIVE CENTER LLC
Entity Type:Organization
Organization Name:LOUISVILLE REPRODUCTIVE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:JP,,
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-897-2144
Mailing Address - Street 1:4123 DUTCHMANS LANE
Mailing Address - Street 2:SUITE 416
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4755
Mailing Address - Country:US
Mailing Address - Phone:502-897-2144
Mailing Address - Fax:502-897-1773
Practice Address - Street 1:4123 DUTCHMANS LANE
Practice Address - Street 2:SUITE 416
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4755
Practice Address - Country:US
Practice Address - Phone:502-897-2144
Practice Address - Fax:502-897-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0006XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Fertility Facility