Basic Information
| Provider Information | |||||||||
| NPI: | 1760452585 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOUISVILLE MEDICAL CENTER PHYSICIANS INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1909 WILLIAMSBURG WAY NE | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446418781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308753366 | ||||||||
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| Address1: | 1909 WILLIAMSBURG WAY NE | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446418781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308753366 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 10/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | PANSINO | ||||||||
| AuthorizedOfficialFirstName: | TERRENCE | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3308753366 | ||||||||
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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 | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0694879 | 05 | OH | MEDICAID |