Provider Demographics
NPI:1013175991
Name:DO NOT USE
Entity type:Organization
Organization Name:DO NOT USE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-238-2801
Mailing Address - Street 1:2600 STANLEY GAULT PKWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4197
Mailing Address - Country:US
Mailing Address - Phone:502-253-1035
Mailing Address - Fax:
Practice Address - Street 1:7092 DISTRIBUTION DR
Practice Address - Street 2:SUITE E
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-2893
Practice Address - Country:US
Practice Address - Phone:502-935-9970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST COMMUNITY HEALTH SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-28
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9538OtherMEDICARE GROUP