Basic Information
| Provider Information | |||||||||
| NPI: | 1669462644 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOWE | ||||||||
| FirstName: | VICKIE | ||||||||
| MiddleName: | CAROL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WHOBREY | ||||||||
| OtherFirstName: | VICKIE | ||||||||
| OtherMiddleName: | C | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 100 E LIBERTY ST | ||||||||
| Address2: | SUITE 800 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025874391 | ||||||||
| FaxNumber: | 5024791425 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 ABRAHAM FLEXNER WAY | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021886 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025874391 | ||||||||
| FaxNumber: | 5024791425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2005 | ||||||||
| LastUpdateDate: | 03/21/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 27635 | KY | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 225400000X | 27635 | KY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 2081H0002X | 27635 | KY | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 201163810A (JPG) | 05 | IN | MEDICAID | 000000050299 | 01 | KY | ANTHEM | OTHER | 64276355 | 05 | KY | MEDICAID | 163857500 | 01 | DEPARTMENT OF LABOR | OTHER | 250006816 | 01 | KY | RAILROAD RETIREMENT | OTHER | 2432324000 | 01 | KY | PASSPORT ADVANTAGE | OTHER | 50030753 | 01 | KY | PASSPORT | OTHER |