Provider Demographics
NPI:1851473391
Name:SOUTH LOUISVILLE PEDIATRICS PSC
Entity Type:Organization
Organization Name:SOUTH LOUISVILLE PEDIATRICS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-448-7853
Mailing Address - Street 1:5129 DIXIE HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216
Mailing Address - Country:US
Mailing Address - Phone:502-448-7853
Mailing Address - Fax:502-448-0201
Practice Address - Street 1:5129 DIXIE HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216
Practice Address - Country:US
Practice Address - Phone:502-448-7853
Practice Address - Fax:502-448-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty