Provider Demographics
NPI:1942232905
Name:UNIVERSITY PHYSICIAN ASSOCIATES
Entity Type:Organization
Organization Name:UNIVERSITY PHYSICIAN ASSOCIATES
Other - Org Name:UPA UROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-562-5762
Mailing Address - Street 1:501 E BROADWAY
Mailing Address - Street 2:STE 290
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1785
Mailing Address - Country:US
Mailing Address - Phone:502-217-8221
Mailing Address - Fax:502-217-5056
Practice Address - Street 1:550 S JACKSON ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1622
Practice Address - Country:US
Practice Address - Phone:502-562-6511
Practice Address - Fax:502-562-6512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY31000102Medicaid
KY50006485OtherPASSPORT HEALTH PLAN
0000000552733OtherANTHEM
KY7661Medicare PIN