Provider Demographics
NPI:1851378590
Name:UNIVERSITY PATHOLOGISTS, PSC
Entity Type:Organization
Organization Name:UNIVERSITY PATHOLOGISTS, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:502-852-1648
Mailing Address - Street 1:PO BOX 967
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0967
Mailing Address - Country:US
Mailing Address - Phone:502-852-1648
Mailing Address - Fax:502-852-2046
Practice Address - Street 1:530 S. JACKSON ST.
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-852-6395
Practice Address - Fax:502-852-1761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-23
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65-922759Medicaid
KY8281174OtherAETNA
KY000000060193OtherANTHEM
IN100396660OtherMEDICAID
KYCD3801OtherRR MEDICARE
IN100396660OtherMEDICAID
KYCD3801OtherRR MEDICARE