Basic Information
| Provider Information | |||||||||
| NPI: | 1083085815 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY KIDNEY CENTER-LOUISVILLE LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | UNIVERSITY KIDNEY CENTER 3RD STREET | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 635 S 3RD ST | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402022401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025611314 | ||||||||
| FaxNumber: | 5025611840 | ||||||||
| Practice Location | |||||||||
| Address1: | 635 S 3RD ST | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402022401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025611314 | ||||||||
| FaxNumber: | 5025611840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2015 | ||||||||
| LastUpdateDate: | 08/18/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GREENE | ||||||||
| AuthorizedOfficialFirstName: | KEISHA | ||||||||
| AuthorizedOfficialMiddleName: | DENISE | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OF CLINICAL & REGULATORY | ||||||||
| AuthorizedOfficialTelephone: | 9785223905 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
No ID Information.