Provider Demographics
NPI:1811378524
Name:EAST LOUISVILLE INTERVENTIONAL PAIN SPECIALISTS PLLC
Entity Type:Organization
Organization Name:EAST LOUISVILLE INTERVENTIONAL PAIN SPECIALISTS PLLC
Other - Org Name:ELIPS SCRIPTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-939-6085
Mailing Address - Street 1:3206 WILDWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-8232
Mailing Address - Country:US
Mailing Address - Phone:502-939-6085
Mailing Address - Fax:
Practice Address - Street 1:4205 SPRINGHURST BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-6159
Practice Address - Country:US
Practice Address - Phone:502-290-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP076943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2152529OtherPK