Provider Demographics
NPI:1407820533
Name:GREATER LOUISVILLE INTERNAL MEDICINE PSC
Entity Type:Organization
Organization Name:GREATER LOUISVILLE INTERNAL MEDICINE PSC
Other - Org Name:CILIBERTI, WIJANGCO & BOSLER, PSC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:CILIBERTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-587-0521
Mailing Address - Street 1:9517 US HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-9237
Mailing Address - Country:US
Mailing Address - Phone:502-587-0521
Mailing Address - Fax:502-587-3901
Practice Address - Street 1:9517 US HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-9237
Practice Address - Country:US
Practice Address - Phone:502-587-0521
Practice Address - Fax:502-587-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65901316Medicaid
KYCA5672Medicare PIN
KY0782Medicare PIN
KY3883Medicare PIN
KY65901316Medicaid