Provider Demographics
NPI:1144405770
Name:C. DOUGLAS HENSLEY
Entity Type:Organization
Organization Name:C. DOUGLAS HENSLEY
Other - Org Name:LOUISVILLE SKIN AND CANCER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:HENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-254-2300
Mailing Address - Street 1:305B MIDDLETOWN PARK PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2514
Mailing Address - Country:US
Mailing Address - Phone:502-254-2300
Mailing Address - Fax:502-254-7087
Practice Address - Street 1:305B MIDDLETOWN PARK PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2514
Practice Address - Country:US
Practice Address - Phone:502-254-2300
Practice Address - Fax:502-254-7087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28377261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2920Medicare PIN
KYE76172Medicare UPIN
KY0292001Medicare PIN