Provider Demographics
NPI:1336111376
Name:LOUISVILLE PULMONARY ASSOCIATES, PSC
Entity Type:Organization
Organization Name:LOUISVILLE PULMONARY ASSOCIATES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:RALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:CCPC, LMR
Authorized Official - Phone:502-368-9590
Mailing Address - Street 1:4402 CHURCHMAN AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1190
Mailing Address - Country:US
Mailing Address - Phone:502-368-9590
Mailing Address - Fax:502-368-9616
Practice Address - Street 1:4402 CHURCHMAN AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1190
Practice Address - Country:US
Practice Address - Phone:502-368-9590
Practice Address - Fax:502-368-9616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22609174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CM5707OtherRR MEDICARE
2432231000OtherPASSPORT ADVANTAGE
KY3385Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
IN213320Medicare PIN