Basic Information
| Provider Information | |||||||||
| NPI: | 1104925023 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMONS | ||||||||
| FirstName: | RUTH | ||||||||
| MiddleName: | MARGARET | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776347 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3 AUDUBON PLAZA DR STE 610 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402171362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026368334 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 08/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | KY 38762 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 38762 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0002X | 38762 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 50007366 | 01 | PASSPORT | OTHER | P00915027 | 01 | KY | MEDICARE RR | OTHER | 64104961 | 05 | KY | MEDICAID |