Provider Demographics
NPI:1881697464
Name:CLINICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:CLINICAL ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR FINANCE BILLING
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-897-9594
Mailing Address - Street 1:PO BOX 538359
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-8359
Mailing Address - Country:US
Mailing Address - Phone:502-897-9594
Mailing Address - Fax:502-896-1808
Practice Address - Street 1:2935 BRECKENRIDGE LN STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1408
Practice Address - Country:US
Practice Address - Phone:502-897-9594
Practice Address - Fax:502-896-1808
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTON ENTERPRISES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-27
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200291291U00000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000061989OtherANTHEM WELLPOINT
KY65908972Medicaid
KY1049047OtherPASSPORT KY MEDICAID
KY020379400OtherBLACK LUNG PROGRAM
KY2432349000OtherPASSPORT ADVANTAGE
IN100009130Medicaid
KY000000058863OtherANTHEM - - BLUE CROSS BLUE SHIELD
KY163387800OtherFECA
KY2432349000OtherPASSPORT ADVANTAGE
KY690000404Medicare PIN
KY4015001Medicare PIN
KY65908972Medicaid