Basic Information
| Provider Information | |||||||||
| NPI: | 1205087467 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHEST MEDICINE ASSOCIATES P.S.C | ||||||||
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| OtherOrganizationName: | SLEEP MEDICINE SPECIALISTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1169 EASTERN PKWY | ||||||||
| Address2: | SUITE 2266 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402171417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022383178 | ||||||||
| FaxNumber: | 5022383653 | ||||||||
| Practice Location | |||||||||
| Address1: | 313 FEDERAL DR NW | ||||||||
| Address2: | SUITE 40 | ||||||||
| City: | CORYDON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471123070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024599127 | ||||||||
| FaxNumber: | 5024518744 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2008 | ||||||||
| LastUpdateDate: | 10/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | BOATWRIGHT | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5024599127 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0012X | IN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine |
ID Information
| ID | Type | State | Issuer | Description | 65934184 | 05 | KY | MEDICAID |