Provider Demographics
NPI:1982865556
Name:SPALDING UNIVERSITY
Entity Type:Organization
Organization Name:SPALDING UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TORI
Authorized Official - Middle Name:MURDEN
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:JD,
Authorized Official - Phone:502-588-7164
Mailing Address - Street 1:845 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2213
Mailing Address - Country:US
Mailing Address - Phone:502-873-4219
Mailing Address - Fax:502-585-7149
Practice Address - Street 1:812 S 2ND ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2210
Practice Address - Country:US
Practice Address - Phone:502-873-4223
Practice Address - Fax:502-333-9743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101189251S00000X, 261QR0400X
252Y00000X, 261QC1500X
KY261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100248870Medicaid
18-4534Medicare PIN