Provider Demographics
NPI:1942231626
Name:UOFL RESEARCH FOUNDATION
Entity Type:Organization
Organization Name:UOFL RESEARCH FOUNDATION
Other - Org Name:WINGS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN OF DEPARTMENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
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:40202-1785
Mailing Address - Country:US
Mailing Address - Phone:502-562-6810
Mailing Address - Fax:502-562-6777
Practice Address - Street 1:550 S JACKSON ST
Practice Address - Street 2:2ND FLOOR, ACB
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1622
Practice Address - Country:US
Practice Address - Phone:502-561-8844
Practice Address - Fax:502-561-8843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS31000102Medicaid
KY2711Medicare ID - Type Unspecified