Provider Demographics
NPI:1689607129
Name:HUBBARD CLINIC & CENTER FOR BLADDER CONTROL, LLC
Entity Type:Organization
Organization Name:HUBBARD CLINIC & CENTER FOR BLADDER CONTROL, LLC
Other - Org Name:THE HUBBARD CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GOVERNING BODY / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-893-3510
Mailing Address - Street 1:3924 S DUPONT SQ
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-5912
Mailing Address - Country:US
Mailing Address - Phone:502-893-3510
Mailing Address - Fax:502-894-9863
Practice Address - Street 1:3924 S DUPONT SQ
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5912
Practice Address - Country:US
Practice Address - Phone:502-893-3510
Practice Address - Fax:502-894-9863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6142Medicare ID - Type UnspecifiedMEDICARE GROUP