Provider Demographics
NPI:1629075825
Name:UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION, INC
Entity Type:Organization
Organization Name:UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION, INC
Other - Org Name:KIDNEY DISEASE PROGRAM / LOUISVILLE RENAL DIALYSIS FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF, DIVISION OF NEPHROLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEDERER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-852-5757
Mailing Address - Street 1:615 S PRESTON ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1715
Mailing Address - Country:US
Mailing Address - Phone:502-852-5757
Mailing Address - Fax:502-852-4039
Practice Address - Street 1:615 S PRESTON ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1715
Practice Address - Country:US
Practice Address - Phone:502-852-5757
Practice Address - Fax:502-852-4039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY182501261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100003040AOtherINDIANA MEDICAID
KY39090030Medicaid
KY000003108HOtherHUMANA HEALTH CARE NUMBER
KY004541476OtherAETNA PROVIDER #
KY50001023Medicaid
KY5416V4981OtherAHDS PROVIDER #
KY000000112462OtherBCBS 12 DIGIT PROVIDER #
KY350OtherBLUE CROSS NUMBER
KY50001023Medicaid