Provider Demographics
NPI: | 1932740487 |
---|---|
Name: | NORTON CHILDREN'S MEDICAL GROUP, LLC |
Entity Type: | Organization |
Organization Name: | NORTON CHILDREN'S MEDICAL GROUP, LLC |
Other - Org Name: | NORTON CHILDREN'S PHYSICAL MEDICINE AND REHABILITATION |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | SYST VP OF MNGD CARE & PAYOR STRAT |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | SHELLEY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GAST |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 502-272-5335 |
Mailing Address - Street 1: | PO BOX 776879 |
Mailing Address - Street 2: | |
Mailing Address - City: | CHICAGO |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60677-6879 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 502-272-5336 |
Mailing Address - Fax: | 502-272-5339 |
Practice Address - Street 1: | 4803 OLYMPIA PARK PLZ STE 1100 |
Practice Address - Street 2: | |
Practice Address - City: | LOUISVILLE |
Practice Address - State: | KY |
Practice Address - Zip Code: | 40241-3068 |
Practice Address - Country: | US |
Practice Address - Phone: | 502-272-5336 |
Practice Address - Fax: | 502-272-5339 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-10-07 |
Last Update Date: | 2021-09-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2081P0010X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pediatric Rehabilitation Medicine | Group - Single Specialty |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Single Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Single Specialty | |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Single Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Single Specialty | |
No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Single Specialty |
No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Single Specialty |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Single Specialty | |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Single Specialty |