Provider Demographics
NPI:1477721801
Name:PRESTON STATION OCCUPATIONAL HEALTH SERVICES, PSC
Entity Type:Organization
Organization Name:PRESTON STATION OCCUPATIONAL HEALTH SERVICES, PSC
Other - Org Name:RIVER CITY HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:URDA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:502-375-3242
Mailing Address - Street 1:1941 BISHOP LN STE 205
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1973
Mailing Address - Country:US
Mailing Address - Phone:502-499-2197
Mailing Address - Fax:502-499-2198
Practice Address - Street 1:1941 BISHOP LN STE 205
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1973
Practice Address - Country:US
Practice Address - Phone:502-375-3242
Practice Address - Fax:502-375-4331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02528207Q00000X, 2083X0100X
KY3005276363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty