Provider Demographics
NPI:1295550135
Name:A-LIST MEDICAL LLC
Entity type:Organization
Organization Name:A-LIST MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ELAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-417-8600
Mailing Address - Street 1:3008 CHRISTIANA WOODS CT STE 100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2903
Mailing Address - Country:US
Mailing Address - Phone:502-780-1418
Mailing Address - Fax:
Practice Address - Street 1:3841 RUCKRIEGEL PKWY STE 104
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-3986
Practice Address - Country:US
Practice Address - Phone:502-417-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-16
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty