TABLER CLINICAL SERVICES, PSC

Provider Demographics

• NPI: 1437187507
• Name: TABLER CLINICAL SERVICES, PSC
• Entity Type: Organization
• Organization Name: TABLER CLINICAL SERVICES, PSC
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - Prefix: DR
• Authorized Official - First Name: JAMES
• Authorized Official - Middle Name: BOSWELL
• Authorized Official - Last Name: TABLER
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 502-721-7575
• Mailing Address - Street 1: 173 SEARS AVE
• Mailing Address - Street 2: SUITE 274
• Mailing Address - City: LOUISVILLE
• Mailing Address - State: KY
• Mailing Address - Zip Code: 40207-5059
• Mailing Address - Country: US
• Mailing Address - Phone: 502-721-7575
• Mailing Address - Fax: 502-721-9682
• Practice Address - Street 1: 173 SEARS AVE
• Practice Address - Street 2: SUITE 274
• Practice Address - City: LOUISVILLE
• Practice Address - State: KY
• Practice Address - Zip Code: 40207-5059
• Practice Address - Country: US
• Practice Address - Phone: 502-721-7575
• Practice Address - Fax: 502-721-9682
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-06-29
• Last Update Date: 2014-06-05

Provider Licenses

State	License ID	Taxonomies
KY	24856	2084P0800X, 2084P0805X
		363LF0000X, 363LP0808X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	2084P0800X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Psychiatry	Group - Multi-Specialty
No	2084P0805X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Geriatric Psychiatry	Group - Multi-Specialty
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Multi-Specialty
No	363LP0808X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Psychiatric/Mental Health	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
KY	000000069035	Other	ANTHEM
KY	7100101770	Medicaid
KY	78902996	Medicaid
IN	107287	Other	SIHO
IN	100027380	Medicaid
KY	78902996	Medicaid
KY	000000069035	Other	ANTHEM
IN	100357460A	Medicaid
IN	TB1240	Medicare ID - Type Unspecified
IN	129780A	Medicare ID - Type Unspecified
KY	78004611	Medicaid
KY	0576201	Medicare ID - Type Unspecified
KY	0576210	Medicare ID - Type Unspecified
IN	2003464810	Medicaid
KY	78004611	Medicaid
KY	0576201	Medicare ID - Type Unspecified
KY	S70281	Medicare UPIN
KY	64248560	Medicaid
KY	0576210	Medicare ID - Type Unspecified
IN	2003464810	Medicaid