Provider Demographics
NPI:1134174360
Name:UNIVERSITY OBSTETRICAL AND GYNECOLOGICAL ASSOCIATES, PSC
Entity type:Organization
Organization Name:UNIVERSITY OBSTETRICAL AND GYNECOLOGICAL ASSOCIATES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSOR AND CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-271-5999
Mailing Address - Street 1:550 S JACKSON ST
Mailing Address - Street 2:UNIVERSITY OF LOUISVILLE DEPT. OF OB/GYN
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 E CHESTNUT ST
Practice Address - Street 2:SUITE 410
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5700
Practice Address - Country:US
Practice Address - Phone:502-271-5999
Practice Address - Fax:502-271-5994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY363LW0102X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1049267OtherPASSPORT SPECIALTY
KY000000057500OtherANTHEM
KY65900631Medicaid
IN100033630Medicaid
KY7100023320Medicaid
KY2757Medicare PIN
KY000000057500OtherANTHEM