Provider Demographics
NPI:1508012477
Name:TOMMY L LOUISVILLE MD PA
Entity Type:Organization
Organization Name:TOMMY L LOUISVILLE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOUISVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-452-1980
Mailing Address - Street 1:1598 US 27 N
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-2151
Mailing Address - Country:US
Mailing Address - Phone:863-452-1980
Mailing Address - Fax:407-386-3342
Practice Address - Street 1:1598 US 27 N
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-2151
Practice Address - Country:US
Practice Address - Phone:863-452-1980
Practice Address - Fax:407-386-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4663Medicare PIN