Basic Information
| Provider Information | |||||||||
| NPI: | 1629076716 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEDIATRIC PARTNERS OF JEFFERSONTOWN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3840 RUCKRIEGEL PKWY | ||||||||
| Address2: | STE105 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402996835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022617227 | ||||||||
| FaxNumber: | 8449659615 | ||||||||
| Practice Location | |||||||||
| Address1: | 3840 RUCKRIEGEL PKWY | ||||||||
| Address2: | STE105 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402993986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022617227 | ||||||||
| FaxNumber: | 5022617157 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | PAPPALARDO | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | CHARLES | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 5022617227 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.