Basic Information
| Provider Information | |||||||||
| NPI: | 1164442604 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOUISVILLE ENDOCRINE CONSULTANTS, PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 W. BROADWAY | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402023245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022389911 | ||||||||
| FaxNumber: | 5022389912 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 BLUEGRASS AVENUE | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402151144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023612524 | ||||||||
| FaxNumber: | 5023612525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 12/09/2009 | ||||||||
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| AuthorizedOfficialLastName: | KARNES | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 5022389911 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RE0101X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 65944753 | 05 | KY | MEDICAID | 200854640 | 05 | IN | MEDICAID | DF0202 | 01 | KY | RAILROAD MEDICARE KY | OTHER |