Provider Demographics
NPI:1164754958
Name:LOUISVILLE GASTROENTEROLOGY ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:LOUISVILLE GASTROENTEROLOGY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MINTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-452-9567
Mailing Address - Street 1:1169 EASTERN PKWY
Mailing Address - Street 2:SUITE G58
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1417
Mailing Address - Country:US
Mailing Address - Phone:502-452-9567
Mailing Address - Fax:502-473-0586
Practice Address - Street 1:1169 EASTERN PKWY
Practice Address - Street 2:SUITE G58
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1417
Practice Address - Country:US
Practice Address - Phone:502-452-9567
Practice Address - Fax:502-473-0586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty