Provider Demographics
NPI:1497700850
Name:FAMILY PRACTICE CENTER OF LOUISVILLE, INC
Entity Type:Organization
Organization Name:FAMILY PRACTICE CENTER OF LOUISVILLE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHARINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:TABB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-875-3353
Mailing Address - Street 1:1303 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-8737
Mailing Address - Country:US
Mailing Address - Phone:330-875-3353
Mailing Address - Fax:330-875-2746
Practice Address - Street 1:1303 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641-8737
Practice Address - Country:US
Practice Address - Phone:330-875-3353
Practice Address - Fax:330-875-2746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH285505380-00OtherWORKERS COMPENSATION
OH000000164947OtherANTHEM GROUP #
OH0430528Medicaid
OH2154476Medicaid
OH0434239Medicaid
OHA79396Medicare UPIN
OH0430528Medicaid
OH285505380-00OtherWORKERS COMPENSATION
OH2154476Medicaid