Provider Demographics
| NPI: | 1932740487 |
|---|---|
| Name: | NORTON CHILDREN'S MEDICAL GROUP, LLC |
| Entity type: | Organization |
| Organization Name: | NORTON CHILDREN'S MEDICAL GROUP, LLC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | SYST VP OF MNGD CARE & PAYOR STRAT |
| Authorized Official - Prefix: | MS |
| Authorized Official - First Name: | SHELLEY |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | GAST |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 502-272-5335 |
| Mailing Address - Street 1: | PO BOX 776879 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | CHICAGO |
| Mailing Address - State: | IL |
| Mailing Address - Zip Code: | 60677-6879 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 502-272-5336 |
| Mailing Address - Fax: | 502-272-5339 |
| Practice Address - Street 1: | 4803 OLYMPIA PARK PLZ STE 1100 |
| Practice Address - Street 2: | |
| Practice Address - City: | LOUISVILLE |
| Practice Address - State: | KY |
| Practice Address - Zip Code: | 40241-3068 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 502-272-5336 |
| Practice Address - Fax: | 502-272-5339 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2019-10-07 |
| Last Update Date: | 2021-09-22 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 2081P0010X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pediatric Rehabilitation Medicine | Group - Single Specialty |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Single Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Single Specialty | |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Single Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Single Specialty | |
| No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Single Specialty |
| No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Single Specialty |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Single Specialty | |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Single Specialty |
