Provider Demographics
NPI:1750307393
Name:AMIN'S FAMILY PRACTICE ASSOCIATES , PSC
Entity Type:Organization
Organization Name:AMIN'S FAMILY PRACTICE ASSOCIATES , PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-637-1005
Mailing Address - Street 1:1505 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-1710
Mailing Address - Country:US
Mailing Address - Phone:502-637-1005
Mailing Address - Fax:502-635-0046
Practice Address - Street 1:1505 S 7TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-1710
Practice Address - Country:US
Practice Address - Phone:502-637-1005
Practice Address - Fax:502-635-0046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19340207Q00000X
208D00000X, 363LA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1050007OtherPASSPORT HEALTH PLAN
KY2432749001OtherPASSPORT ADVANTAGE
KY2432748001OtherPASSPORT ADVANTAGE
KY1050006OtherPASSPORT HEALTH PLAN
KY65911745Medicaid
KY2432747001OtherPASSPORT ADVANTAGE
KY1050005OtherPASSPORT HEALTH PLAN
KYCK1376Medicare PIN
KY3801Medicare PIN
KY3802Medicare PIN
KY2432747001OtherPASSPORT ADVANTAGE