Provider Demographics
NPI:1740321082
Name:ROLIMAR, PSC.
Entity type:Organization
Organization Name:ROLIMAR, PSC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:A
Authorized Official - Last Name:PENNE-CASANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-899-6100
Mailing Address - Street 1:PO BOX 847
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-0847
Mailing Address - Country:US
Mailing Address - Phone:502-753-0680
Mailing Address - Fax:502-753-0687
Practice Address - Street 1:3991 DUTCHMANS LN
Practice Address - Street 2:SUITE G03
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4700
Practice Address - Country:US
Practice Address - Phone:502-899-6100
Practice Address - Fax:502-899-6108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY370742083P0011X, 2083P0500X
324500000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1170389OtherPASSPORT HEALTH PLAN
KY65937617Medicaid
IN200386450AMedicaid
KYP00022895OtherRAILROAD MEDICARE
KY000000235989OtherANTHEM BLUE CROSS BLUE SHIELD
KY2440624000OtherPASSPORT ADVANTAGE
KY65937617Medicaid