Provider Demographics
NPI:1710469994
Name:EDUMEDICS
Entity Type:Organization
Organization Name:EDUMEDICS
Other - Org Name:EDUMEDICS - KINDRED
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:AUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-569-1044
Mailing Address - Street 1:201 E JEFFERSON ST
Mailing Address - Street 2:STE 102
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-569-1044
Mailing Address - Fax:502-569-0309
Practice Address - Street 1:201 E JEFFERSON ST.
Practice Address - Street 2:STE 102
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-569-1044
Practice Address - Fax:502-569-0309
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDUMEDICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty