Provider Demographics
NPI:1558459917
Name:BULLITT COUNTY FAMILY PRACTITIONERS PSC
Entity Type:Organization
Organization Name:BULLITT COUNTY FAMILY PRACTITIONERS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ARLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-955-4889
Mailing Address - Street 1:170 DR ARLA WAY STE 1
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-5427
Mailing Address - Country:US
Mailing Address - Phone:502-955-4889
Mailing Address - Fax:502-957-1201
Practice Address - Street 1:170 DR ARLA WAY STE 1
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-5427
Practice Address - Country:US
Practice Address - Phone:502-955-4889
Practice Address - Fax:502-957-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYI44666Medicare UPIN
KYC74082Medicare UPIN
KYH87454Medicare UPIN
KYI10108Medicare UPIN