Provider Demographics
NPI:1740314541
Name:U OF L CHILDREN'S SLEEP MEDICINE
Entity type:Organization
Organization Name:U OF L CHILDREN'S SLEEP MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-852-1297
Mailing Address - Street 1:234 E GRAY ST STE 568
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1914
Mailing Address - Country:US
Mailing Address - Phone:502-852-1297
Mailing Address - Fax:502-852-8556
Practice Address - Street 1:501 E BROADWAY STE 280
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1785
Practice Address - Country:US
Practice Address - Phone:502-852-1297
Practice Address - Fax:502-852-8556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65933384Medicaid