Provider Demographics
NPI:1780853846
Name:MARK CHARIKER, M.D., PSC
Entity Type:Organization
Organization Name:MARK CHARIKER, M.D., PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-568-4800
Mailing Address - Street 1:222 S 1ST ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-5404
Mailing Address - Country:US
Mailing Address - Phone:502-568-4800
Mailing Address - Fax:502-589-6882
Practice Address - Street 1:222 S 1ST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5404
Practice Address - Country:US
Practice Address - Phone:502-568-4800
Practice Address - Fax:502-589-6882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64006828Medicaid
KY64006828Medicaid
KY01267Medicare PIN