Basic Information
| Provider Information | |||||||||
| NPI: | 1881666949 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY PSYCHIATRIC SERVICES, PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 69 | ||||||||
| Address2: | ATTENTION JENNIFER FOLEY | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402010069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028126655 | ||||||||
| FaxNumber: | 5028136665 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 S JACKSON ST | ||||||||
| Address2: | ATTENTION: JENNIFER FOLEY | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028136655 | ||||||||
| FaxNumber: | 5028136665 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2006 | ||||||||
| LastUpdateDate: | 03/17/2010 | ||||||||
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| AuthorizedOfficialLastName: | TASMAN | ||||||||
| AuthorizedOfficialFirstName: | ALLAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5028525392 | ||||||||
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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 | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 65907198 | 05 | KY | MEDICAID | CC3957 | 01 | KY | RAILROAD MEDICARE | OTHER | C11618 | 01 | KY | RAILROAD MEDICARE | OTHER |