Provider Demographics
NPI:1497700587
Name:THE UNIVERSITY GYNECOLOGICAL & OBSTETRICAL FOUNDATION, INC.
Entity Type:Organization
Organization Name:THE UNIVERSITY GYNECOLOGICAL & OBSTETRICAL FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSOR AND CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-561-8850
Mailing Address - Street 1:550 S JACKSON ST
Mailing Address - Street 2:ATTN: VICKI MASTERSON UNIVERSITY OF LOUISVILLE
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 S JACKSON ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1622
Practice Address - Country:US
Practice Address - Phone:502-561-8850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1049254OtherPASSPORT SPECIALTY GROUP NUMBER
KY65907222Medicaid
KY789038200Medicaid
KY1051458OtherPASSPORT PRIMARY CARE GROUP NUMBER
KY000000058997OtherANTHEM
IN100004330Medicaid
KY1051458OtherPASSPORT PRIMARY CARE GROUP NUMBER