Provider Demographics
NPI:1144417353
Name:LOUISVILLE EAST PRIMARY CARE
Entity Type:Organization
Organization Name:LOUISVILLE EAST PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-327-5135
Mailing Address - Street 1:213 N HURSTBOURNE PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5139
Mailing Address - Country:US
Mailing Address - Phone:502-327-5135
Mailing Address - Fax:502-327-9475
Practice Address - Street 1:213 N HURSTBOURNE PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5139
Practice Address - Country:US
Practice Address - Phone:502-327-5135
Practice Address - Fax:502-327-9475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYG66455Medicare UPIN
G23335Medicare UPIN