Basic Information
| Provider Information | |||||||||
| NPI: | 1457435828 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAMES E SEGAL PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4121 DUTCHMANS LN | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028979416 | ||||||||
| FaxNumber: | 5028968660 | ||||||||
| Practice Location | |||||||||
| Address1: | 4121 DUTCHMANS LN | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028979416 | ||||||||
| FaxNumber: | 5028968660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 02/24/2009 | ||||||||
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| AuthorizedOfficialLastName: | SEGAL | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLO MEMBER OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5028972531 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 29732 | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 000000190952 | 01 | KY | ANTHEM | OTHER | 2441827000 | 01 | KY | PASSPORT ADVANTAGE | OTHER | 50000109 | 01 | KY | PASSPORT | OTHER | 64297328 | 05 | KY | MEDICAID |