Provider Demographics
NPI:1346472750
Name:LOUISVILLE PALLIATIVE CARE LLC
Entity Type:Organization
Organization Name:LOUISVILLE PALLIATIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CORNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-262-5172
Mailing Address - Street 1:5644 RELIABLE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0056
Mailing Address - Country:US
Mailing Address - Phone:502-262-5172
Mailing Address - Fax:502-244-6249
Practice Address - Street 1:3625 FERN VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-1916
Practice Address - Country:US
Practice Address - Phone:502-262-5172
Practice Address - Fax:502-244-6249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25867207RH0002X
KY3006302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100149990Medicaid
KY7100149990Medicaid
KY01068Medicare PIN
KY7100190240Medicaid