Provider Demographics
NPI:1417902925
Name:UNIVERSITY MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:UNIVERSITY MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SNAWDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-589-4856
Mailing Address - Street 1:501 E BROADWAY
Mailing Address - Street 2:STE 200
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-589-4856
Mailing Address - Fax:502-589-5093
Practice Address - Street 1:401 E CHESTNUT STREET
Practice Address - Street 2:STE 310
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-589-4856
Practice Address - Fax:502-589-5093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65902447Medicaid
IN100003580Medicaid
KY65902447Medicaid
IN244650Medicare PIN
IN100003580Medicaid
KY5478Medicare PIN