Provider Demographics
NPI:1134453582
Name:PARTNERS IN PALLIATIVE CARE PLLC
Entity type:Organization
Organization Name:PARTNERS IN PALLIATIVE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACI
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANDROLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-693-2681
Mailing Address - Street 1:5672 RELIABLE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0056
Mailing Address - Country:US
Mailing Address - Phone:502-637-4579
Mailing Address - Fax:502-813-3444
Practice Address - Street 1:7504 WESTPORT RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4108
Practice Address - Country:US
Practice Address - Phone:502-693-2681
Practice Address - Fax:502-495-9738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41139207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50026941OtherPASSPORT
KY000000625202OtherANTHEM
KY3756447000OtherPASSPORT ADVANTAGE
KY7100105330Medicaid
KY50026941OtherPASSPORT
KYDP7221Medicare PIN