Provider Demographics
NPI:1952532665
Name:UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION INC
Entity Type:Organization
Organization Name:UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION INC
Other - Org Name:CHILDREN AND YOUTH DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEE ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MINGUS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:502-852-5588
Mailing Address - Street 1:555 S FLOYD ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3822
Mailing Address - Country:US
Mailing Address - Phone:502-852-5588
Mailing Address - Fax:502-852-5630
Practice Address - Street 1:555 S FLOYD ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3822
Practice Address - Country:US
Practice Address - Phone:502-852-5588
Practice Address - Fax:502-852-5630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY45659976Medicaid