Provider Demographics
NPI:1336804905
Name:BULLITT COUNTY FAMILY PRACTITIONER
Entity Type:Organization
Organization Name:BULLITT COUNTY FAMILY PRACTITIONER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:ARLA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:502-418-9138
Mailing Address - Street 1:170 DR ARLA WAY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-5427
Mailing Address - Country:US
Mailing Address - Phone:502-955-8480
Mailing Address - Fax:
Practice Address - Street 1:170 DR ARLA WAY
Practice Address - Street 2:SUITE 4
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-5427
Practice Address - Country:US
Practice Address - Phone:502-955-8480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory