Basic Information
| Provider Information | |||||||||
| NPI: | 1972962769 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EUDAIMONIA PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 407 WENDOVER AVE | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402073770 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1313 SAINT ANTHONY PL | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402041740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3134432127 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2016 | ||||||||
| LastUpdateDate: | 08/18/2016 | ||||||||
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| AuthorizedOfficialLastName: | SANCHEZ | ||||||||
| AuthorizedOfficialFirstName: | KATHRYN | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3134432127 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 50103566 | 01 | KY | PASSPORT HEALTH PLAN | OTHER | DW6836 | 01 | KY | RAILROAD MEDICARE | OTHER | DW4020 | 01 | IN | RAILROAD MEDICARE | OTHER | 201346060 | 05 | IN | MEDICAID | 7100405740 | 05 | KY | MEDICAID |