Provider Demographics
NPI:1629076716
Name:PEDIATRIC PARTNERS OF JEFFERSONTOWN
Entity Type:Organization
Organization Name:PEDIATRIC PARTNERS OF JEFFERSONTOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:PAPPALARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-261-7227
Mailing Address - Street 1:3840 RUCKRIEGEL PKWY
Mailing Address - Street 2:STE105
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-6835
Mailing Address - Country:US
Mailing Address - Phone:502-261-7227
Mailing Address - Fax:844-965-9615
Practice Address - Street 1:3840 RUCKRIEGEL PKWY
Practice Address - Street 2:STE105
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-3986
Practice Address - Country:US
Practice Address - Phone:502-261-7227
Practice Address - Fax:502-261-7157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty