Provider Demographics
NPI:1720009665
Name:PROMPTCARE PHYSICIAN GROUP PLLC
Entity Type:Organization
Organization Name:PROMPTCARE PHYSICIAN GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SHANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-412-1112
Mailing Address - Street 1:3215 WESTPORT GREEN PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-3135
Mailing Address - Country:US
Mailing Address - Phone:502-412-1112
Mailing Address - Fax:502-357-0606
Practice Address - Street 1:3215 WESTPORT GREEN PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-3135
Practice Address - Country:US
Practice Address - Phone:502-412-1112
Practice Address - Fax:502-357-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000061352OtherANTHEM BSBS
KY000000061352OtherANTHEM BSBS