Provider Demographics
NPI:1881666949
Name:UNIVERSITY PSYCHIATRIC SERVICES, PSC
Entity Type:Organization
Organization Name:UNIVERSITY PSYCHIATRIC SERVICES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TASMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-852-5392
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:ATTENTION JENNIFER FOLEY
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0069
Mailing Address - Country:US
Mailing Address - Phone:502-812-6655
Mailing Address - Fax:502-813-6665
Practice Address - Street 1:550 S JACKSON ST
Practice Address - Street 2:ATTENTION: JENNIFER FOLEY
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1622
Practice Address - Country:US
Practice Address - Phone:502-813-6655
Practice Address - Fax:502-813-6665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65907198Medicaid
KYCC3957OtherRAILROAD MEDICARE
KYC11618OtherRAILROAD MEDICARE
KY0602Medicare PIN
KY057357000Medicare UPIN
KYCC3957OtherRAILROAD MEDICARE
KYC11618Medicare PIN