Provider Demographics
NPI:1154460079
Name:SPRINGHURST PEDIATRICS PLLC
Entity Type:Organization
Organization Name:SPRINGHURST PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SELMA
Authorized Official - Middle Name:P
Authorized Official - Last Name:WINNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-339-0444
Mailing Address - Street 1:10210 WESTPORT RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2148
Mailing Address - Country:US
Mailing Address - Phone:502-339-0444
Mailing Address - Fax:502-339-1717
Practice Address - Street 1:10210 WESTPORT RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2148
Practice Address - Country:US
Practice Address - Phone:502-339-0444
Practice Address - Fax:502-339-1717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23855261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65944084Medicaid