Provider Demographics
NPI:1669589172
Name:NEUROSCIENCE ASSOCIATES PSC
Entity type:Organization
Organization Name:NEUROSCIENCE ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCKIERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-895-7265
Mailing Address - Street 1:3900 KRESGE WAY
Mailing Address - Street 2:SUITE 56
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4683
Mailing Address - Country:US
Mailing Address - Phone:502-895-7265
Mailing Address - Fax:502-897-2113
Practice Address - Street 1:3900 KRESGE WAY
Practice Address - Street 2:SUITE 56
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4683
Practice Address - Country:US
Practice Address - Phone:502-895-7265
Practice Address - Fax:502-897-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65904971Medicaid
CN0117OtherMEDICARE ID
IN100002940Medicaid
KY1049098Medicaid
KY5929OtherANTHEM
KY2848Medicare PIN
KY5929OtherANTHEM
KY6404Medicare PIN
KY6403Medicare PIN
CN0117OtherMEDICARE ID
KY00231Medicare PIN