Provider Demographics
NPI:1902862857
Name:UNIVERSITY PHYSICIAN ASSOCIATES
Entity Type:Organization
Organization Name:UNIVERSITY PHYSICIAN ASSOCIATES
Other - Org Name:U OF L FAMILY MEDICINE GERIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-562-6783
Mailing Address - Street 1:501 E BROADWAY
Mailing Address - Street 2:STE 120
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-562-6783
Mailing Address - Fax:502-562-6777
Practice Address - Street 1:215 CENTRAL AVE
Practice Address - Street 2:102
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208
Practice Address - Country:US
Practice Address - Phone:502-852-7449
Practice Address - Fax:502-852-1423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY31000102Medicaid
KY31000102Medicaid