Provider Demographics
NPI:1891294336
Name:NANNCOH LLC
Entity Type:Organization
Organization Name:NANNCOH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-551-2460
Mailing Address - Street 1:700 ENVOY CIR STE 702
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-1812
Mailing Address - Country:US
Mailing Address - Phone:502-551-2460
Mailing Address - Fax:
Practice Address - Street 1:700 ENVOY CIR STE 702
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-1812
Practice Address - Country:US
Practice Address - Phone:502-551-2460
Practice Address - Fax:502-896-6977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-11
Last Update Date:2018-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty