Basic Information
| Provider Information | |||||||||
| NPI: | 1528118890 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOUISVILLE ENT ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2355 POPLAR LEVEL RD | ||||||||
| Address2: | 400 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402171395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024593760 | ||||||||
| FaxNumber: | 5024593717 | ||||||||
| Practice Location | |||||||||
| Address1: | 2355 POPLAR LEVEL RD | ||||||||
| Address2: | 400 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402171395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024593760 | ||||||||
| FaxNumber: | 5024593717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BRUMITT | ||||||||
| AuthorizedOfficialFirstName: | VICKIE | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MGR | ||||||||
| AuthorizedOfficialTelephone: | 5024593760 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 24518 | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.