Provider Demographics
NPI:1457435828
Name:JAMES E SEGAL PLLC
Entity Type:Organization
Organization Name:JAMES E SEGAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLO MEMBER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-897-2531
Mailing Address - Street 1:4121 DUTCHMANS LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4707
Mailing Address - Country:US
Mailing Address - Phone:502-897-9416
Mailing Address - Fax:502-896-8660
Practice Address - Street 1:4121 DUTCHMANS LN
Practice Address - Street 2:SUITE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4707
Practice Address - Country:US
Practice Address - Phone:502-897-9416
Practice Address - Fax:502-896-8660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29732207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000190952OtherANTHEM
KY2441827000OtherPASSPORT ADVANTAGE
KY50000109OtherPASSPORT
KY64297328Medicaid
DE1566Medicare PIN
7534Medicare PIN
G12126Medicare UPIN