Basic Information
| Provider Information | |||||||||
| NPI: | 1962531731 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOUISVILLE HOSPITALIST ASSOCIATES PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3950 KRESGE WAY | ||||||||
| Address2: | STE 308 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028959627 | ||||||||
| FaxNumber: | 5028958977 | ||||||||
| Practice Location | |||||||||
| Address1: | 3950 KRESGE WAY | ||||||||
| Address2: | STE 308 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028959627 | ||||||||
| FaxNumber: | 5028958977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 07/30/2019 | ||||||||
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| AuthorizedOfficialLastName: | RAY | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5028958911 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 208M00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 7100000830 | 05 | KY | MEDICAID | DG0894 | 01 | KY | RAILROAD MEDICARE KY | OTHER |