Provider Demographics
NPI:1346247111
Name:UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION, INC
Entity Type:Organization
Organization Name:UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION, INC
Other - Org Name:RENAL TRANSPLANT LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-852-5865
Mailing Address - Street 1:500 S PRESTON ST
Mailing Address - Street 2:ROOM 126, BLDG 55B
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1702
Mailing Address - Country:US
Mailing Address - Phone:502-852-5865
Mailing Address - Fax:502-852-5782
Practice Address - Street 1:500 S PRESTON ST
Practice Address - Street 2:ROOM 126, BLDG 55B
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1702
Practice Address - Country:US
Practice Address - Phone:502-852-5865
Practice Address - Fax:502-852-5782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200145291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000001555JOtherHUMANA PROV #
KY37902442Medicaid
KY1058952 VEN# 1058830Medicaid
KY50A8OtherBLUE CROSS
IN200073430AMedicaid
KY3580095OtherUNITED HEALTH CARE PROV #
KY000000070124OtherBCBS(NEWER POLICIES)
KY5416V4981OtherHEALTHCARE PREFERRED PROV
KY000000070124OtherBCBS(NEWER POLICIES)
KY4007901Medicare Oscar/Certification