Provider Demographics
NPI:1437539145
Name:SUNSHINE PEDIATRICS OF LOUISVILLE LLC
Entity Type:Organization
Organization Name:SUNSHINE PEDIATRICS OF LOUISVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:F
Authorized Official - Last Name:BRANCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-789-5541
Mailing Address - Street 1:191 MASJID AVE
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-8634
Mailing Address - Country:US
Mailing Address - Phone:606-789-5541
Mailing Address - Fax:606-789-9445
Practice Address - Street 1:822 S MAYO TRL
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1384
Practice Address - Country:US
Practice Address - Phone:606-789-5541
Practice Address - Fax:606-789-9445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty