Provider Demographics
NPI:1841612041
Name:PA PROFESSIONAL CENTER INC
Entity Type:Organization
Organization Name:PA PROFESSIONAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:OSMARO
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-802-3726
Mailing Address - Street 1:4229 BARDSTOWN RD STE 411
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-3241
Mailing Address - Country:US
Mailing Address - Phone:502-802-3726
Mailing Address - Fax:
Practice Address - Street 1:4229 BARDSTOWN RD STE 411
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3241
Practice Address - Country:US
Practice Address - Phone:502-802-3726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service