Provider Demographics
NPI:1811626542
Name:CONNECTMED360
Entity Type:Organization
Organization Name:CONNECTMED360
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:FALKENRATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-360-2633
Mailing Address - Street 1:13410 EASTPOINT CENTRE DR STE 150
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4160
Mailing Address - Country:US
Mailing Address - Phone:833-360-2633
Mailing Address - Fax:833-360-3329
Practice Address - Street 1:13410 EASTPOINT CENTRE DR STE 150
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4160
Practice Address - Country:US
Practice Address - Phone:833-360-2633
Practice Address - Fax:833-360-3329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No333600000XSuppliersPharmacy