Provider Demographics
NPI:1164293908
Name:PEDIATRICS OF BULLITT COUNTY PLLC
Entity Type:Organization
Organization Name:PEDIATRICS OF BULLITT COUNTY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:MILES
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-538-5090
Mailing Address - Street 1:327 EASTBROOKE POINTE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MOUNT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-5577
Mailing Address - Country:US
Mailing Address - Phone:502-538-5090
Mailing Address - Fax:
Practice Address - Street 1:1707 CEDAR GROVE RD STE 20
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-8592
Practice Address - Country:US
Practice Address - Phone:502-215-5090
Practice Address - Fax:502-215-5095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health