Provider Demographics
NPI:1225181639
Name:LOUISVILLE NEUROSURGICAL SPECIALISTS, P.S.C.
Entity Type:Organization
Organization Name:LOUISVILLE NEUROSURGICAL SPECIALISTS, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:PETRUSKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-899-9099
Mailing Address - Street 1:4010 DUPONT CIR
Mailing Address - Street 2:SUITE L-28
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4812
Mailing Address - Country:US
Mailing Address - Phone:502-899-9099
Mailing Address - Fax:502-899-9899
Practice Address - Street 1:4010 DUPONT CIR
Practice Address - Street 2:SUITE L-28
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4812
Practice Address - Country:US
Practice Address - Phone:502-899-9099
Practice Address - Fax:502-899-9899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7902Medicare ID - Type UnspecifiedGROUP