Provider Demographics
NPI:1538309489
Name:CSD MEDICAL SERVICES
Entity Type:Organization
Organization Name:CSD MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, RNFA
Authorized Official - Phone:859-227-4835
Mailing Address - Street 1:18 VILLAGE PLZ
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-1745
Mailing Address - Country:US
Mailing Address - Phone:859-227-4835
Mailing Address - Fax:502-453-0790
Practice Address - Street 1:18 VILLAGE PLZ
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1745
Practice Address - Country:US
Practice Address - Phone:859-227-4835
Practice Address - Fax:502-453-0790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4229P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000562862OtherANTHEM BCBS
KY78014354Medicaid
KY000000562862OtherANTHEM BCBS
KY78014354Medicaid