Provider Demographics
NPI:1265416259
Name:SIMPSON, TINA F (MD)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:F
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:4801 OLYMPIA PARK PLZ
Practice Address - Street 2:SUITE 2200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2090
Practice Address - Country:US
Practice Address - Phone:502-423-9595
Practice Address - Fax:502-719-0161
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31256207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000044684OtherBCBS
KY50037682OtherPASSPORT - WOMEN'S SPECIALISTS
KY610679864FOtherHUMANA
KY1058742Medicaid
KY160029909OtherRR MEDICARE
KY134800OtherSIHO - WS
KY64312564Medicaid
KY000000765748OtherANTHEM - WS
KY50037682OtherPASSPORT - WS
KY000000044684OtherBCBS
KYK039870Medicare PIN
KY1269704Medicare ID - Type Unspecified