Provider Demographics
NPI: | 1861024424 |
---|---|
Name: | NULEASE MEDICAL SOLUTIONS LLC |
Entity Type: | Organization |
Organization Name: | NULEASE MEDICAL SOLUTIONS LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SHANNON |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CALES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 502-492-7455 |
Mailing Address - Street 1: | 5722 OUTER LOOP |
Mailing Address - Street 2: | |
Mailing Address - City: | LOUISVILLE |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 40219-4156 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 502-492-7455 |
Mailing Address - Fax: | 502-921-0222 |
Practice Address - Street 1: | 1327 E BROADWAY ST STE B |
Practice Address - Street 2: | |
Practice Address - City: | CAMPBELLSVILLE |
Practice Address - State: | KY |
Practice Address - Zip Code: | 42718-1599 |
Practice Address - Country: | US |
Practice Address - Phone: | 270-283-4240 |
Practice Address - Fax: | 270-283-4556 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-02-11 |
Last Update Date: | 2022-08-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 207LA0401X | Allopathic & Osteopathic Physicians | Anesthesiology | Addiction Medicine | Group - Multi-Specialty |
No | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | Group - Multi-Specialty |
No | 207QA0401X | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | Group - Multi-Specialty |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
Yes | 207RA0401X | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine | Group - Multi-Specialty |
No | 2084A0401X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | Group - Multi-Specialty |
No | 208VP0000X | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | Group - Multi-Specialty |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KY | 7100713150 | Medicaid | |
KY | 7100713930 | Medicaid | |
KY | 7100687420 | Medicaid |