Provider Demographics
NPI:1881998086
Name:DR HAQ PRIMARY CARE PSC
Entity type:Organization
Organization Name:DR HAQ PRIMARY CARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-797-7870
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:EASTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40018-0123
Mailing Address - Country:US
Mailing Address - Phone:502-797-7870
Mailing Address - Fax:502-587-0390
Practice Address - Street 1:219 E BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2007
Practice Address - Country:US
Practice Address - Phone:502-587-0394
Practice Address - Fax:502-587-0390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care