Provider Demographics
NPI:1396948873
Name:MEDEAST PHYSICIANS PLLC
Entity type:Organization
Organization Name:MEDEAST PHYSICIANS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:F
Authorized Official - Last Name:BOWLDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-893-7462
Mailing Address - Street 1:4003 KRESGE WAY
Mailing Address - Street 2:SUITE 410
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4652
Mailing Address - Country:US
Mailing Address - Phone:502-893-7462
Mailing Address - Fax:502-899-3838
Practice Address - Street 1:4003 KRESGE WAY
Practice Address - Street 2:SUITE 410
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4652
Practice Address - Country:US
Practice Address - Phone:502-893-7462
Practice Address - Fax:502-899-3838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5590Medicare ID - Type UnspecifiedGROUP ID