Provider Demographics
NPI:1851424808
Name:LOUISVILLE AREA PEDIATRICS PSC
Entity Type:Organization
Organization Name:LOUISVILLE AREA PEDIATRICS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:B
Authorized Official - Last Name:LANNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-245-6446
Mailing Address - Street 1:10002 SHELBYVILLE RD
Mailing Address - Street 2:SUTIE 110
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2979
Mailing Address - Country:US
Mailing Address - Phone:502-245-6446
Mailing Address - Fax:502-254-2198
Practice Address - Street 1:10002 SHELBYVILLE RD
Practice Address - Street 2:SUTIE 110
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2979
Practice Address - Country:US
Practice Address - Phone:502-245-6446
Practice Address - Fax:502-254-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty