NORTON CHILDREN'S MEDICAL GROUP, LLC

Provider Demographics

• NPI: 1134760796
• Name: NORTON CHILDREN'S MEDICAL GROUP, LLC
• Entity type: Organization
• Organization Name: NORTON CHILDREN'S MEDICAL GROUP, LLC
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: SYST VP MNGD CARE & PAYOR STRAT
• Authorized Official - Prefix: MS
• Authorized Official - First Name: SHELLEY
• Authorized Official - Last Name: GAST
• Authorized Official - Phone: 502-272-5335
• Mailing Address - Street 1: PO BOX 776879
• Mailing Address - City: CHICAGO
• Mailing Address - State: IL
• Mailing Address - Zip Code: 60677-6879
• Mailing Address - Country: US
• Mailing Address - Phone: 502-272-5336
• Mailing Address - Fax: 502-272-5339
• Practice Address - Street 1: 4803 OLYMPIA PARK PLZ STE 1100
• Practice Address - City: LOUISVILLE
• Practice Address - State: KY
• Practice Address - Zip Code: 40241-3068
• Practice Address - Country: US
• Practice Address - Phone: 502-272-5336
• Practice Address - Fax: 502-272-5339
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2019-10-04
• Last Update Date: 2021-09-22

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	2084N0402X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Neurology with Special Qualifications in Child Neurology	Group - Single Specialty
No	103G00000X	Behavioral Health & Social Service Providers	Clinical Neuropsychologist		Group - Single Specialty
No	1041C0700X	Behavioral Health & Social Service Providers	Social Worker	Clinical	Group - Single Specialty
No	207T00000X	Allopathic & Osteopathic Physicians	Neurological Surgery		Group - Single Specialty
No	2084N0400X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Neurology	Group - Single Specialty
No	2084P0804X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Child & Adolescent Psychiatry	Group - Single Specialty
No	225100000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Physical Therapist		Group - Single Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Single Specialty
No	363AM0700X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant	Medical	Group - Single Specialty
No	363AS0400X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant	Surgical	Group - Single Specialty
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Single Specialty
No	363LP0200X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Pediatrics	Group - Single Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Single Specialty