Provider Demographics
NPI:1982630158
Name:EAST LOUISVILLE PATHOLOGISTS PSC
Entity Type:Organization
Organization Name:EAST LOUISVILLE PATHOLOGISTS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:H
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-897-8226
Mailing Address - Street 1:1169 EASTERN PKWY
Mailing Address - Street 2:SUITE G 71
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1417
Mailing Address - Country:US
Mailing Address - Phone:502-456-6217
Mailing Address - Fax:502-456-4440
Practice Address - Street 1:4000 KRESGE WAY
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4605
Practice Address - Country:US
Practice Address - Phone:502-897-8226
Practice Address - Fax:502-897-8215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000063222OtherANTHEM BL CROSS BL SHIELD
KY0663153OtherCIGNA HEALTHCARE
KY1049930OtherMEDICAID PASSPORT
1527296OtherUNITED MINE WORKERS
FL124519600OtherWORKERS COMP FLORIDA
KY104509OtherHEALTH PARTNERS
IN200219150AOtherMEDICAID INDIANA
CE9643OtherRAILROAD MEDICARE
KY1100181OtherUNITED HEALTHCARE
KY2432719000OtherPASSPORT ADVANTAGE
KY65929226Medicaid
KY65929226Medicaid
IN200219150AOtherMEDICAID INDIANA