Provider Demographics
NPI:1326776717
Name:COMMUNITY MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:COMMUNITY MEDICAL ASSOCIATES, INC.
Other - Org Name:NORTON COMMUNITY MEDICAL ASSOCIATES ANCILLARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-272-5335
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-558-9490
Mailing Address - Fax:
Practice Address - Street 1:3101 POPLAR LEVEL RD STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1076
Practice Address - Country:US
Practice Address - Phone:502-636-7444
Practice Address - Fax:502-636-7112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty