Provider Demographics
NPI:1124375027
Name:UNIVERSITY OF LOUISVILLE PHYSICIANS, INC.
Entity Type:Organization
Organization Name:UNIVERSITY OF LOUISVILLE PHYSICIANS, INC.
Other - Org Name:ULP PEDIATRIC HEALTHY FOR LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF HR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-588-4206
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-0320
Mailing Address - Fax:502-588-0326
Practice Address - Street 1:601 S FLOYD ST
Practice Address - Street 2:SUITE 805
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1835
Practice Address - Country:US
Practice Address - Phone:502-852-7309
Practice Address - Fax:502-852-2908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK015960Medicare PIN