Provider Demographics
NPI:1639594344
Name:ONEMD ST MATTHEWS PLLC
Entity Type:Organization
Organization Name:ONEMD ST MATTHEWS PLLC
Other - Org Name:ONEMD ST. MATTHEWS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-899-7163
Mailing Address - Street 1:2425 LIME KILN LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-3462
Mailing Address - Country:US
Mailing Address - Phone:502-899-7163
Mailing Address - Fax:502-897-9963
Practice Address - Street 1:112 SEARS AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5014
Practice Address - Country:US
Practice Address - Phone:502-238-2163
Practice Address - Fax:502-238-2173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34957207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000026447NOtherHUMANA
KY110235213OtherRAILROAD MEDICARE
KY000000225513OtherANTHEM
KY000000225513OtherANTHEM
KY000026447NOtherHUMANA