Basic Information
| Provider Information | |||||||||
| NPI: | 1487604641 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOUISVILLE EMERGENCY MEDICINE ASSOCIATES PSC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LOUISVILLE EMERGENCY MEDICINE ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6749 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402060749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028997646 | ||||||||
| FaxNumber: | 5028997648 | ||||||||
| Practice Location | |||||||||
| Address1: | 4000 KRESGE WAY | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028997646 | ||||||||
| FaxNumber: | 5028997648 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 12/10/2013 | ||||||||
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| AuthorizedOfficialLastName: | LUNDQUIST | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5028997646 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1048952 | 01 | KY | PASSPORT GROUP # | OTHER | 000000059904 | 01 | KY | ANTHEM/BLUE CROSS GROUP # | OTHER | 65917445 | 05 | KY | MEDICAID |