Provider Demographics
NPI:1811775679
Name:SHIVELY FIRST HEALTH CARE, LLC
Entity type:Organization
Organization Name:SHIVELY FIRST HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PANTESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-259-8811
Mailing Address - Street 1:3934 DIXIE HWY STE 320
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-4198
Mailing Address - Country:US
Mailing Address - Phone:502-200-1335
Mailing Address - Fax:866-715-7614
Practice Address - Street 1:3934 DIXIE HWY STE 320
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4198
Practice Address - Country:US
Practice Address - Phone:502-200-1335
Practice Address - Fax:866-715-7614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-21
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty