Provider Demographics
NPI:1760713796
Name:PEDIATRIC AND ADULT PROMPT CARE LLC
Entity Type:Organization
Organization Name:PEDIATRIC AND ADULT PROMPT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AKASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-587-0394
Mailing Address - Street 1:614 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2212
Mailing Address - Country:US
Mailing Address - Phone:502-587-0394
Mailing Address - Fax:502-587-0390
Practice Address - Street 1:614 W BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2212
Practice Address - Country:US
Practice Address - Phone:502-587-0394
Practice Address - Fax:502-587-0390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
KY208000000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty