Provider Demographics
NPI:1285984484
Name:PRESTON MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:PRESTON MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-614-7403
Mailing Address - Street 1:5703 PRESTON HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-1305
Mailing Address - Country:US
Mailing Address - Phone:502-614-7403
Mailing Address - Fax:502-410-0447
Practice Address - Street 1:5703 PRESTON HWY
Practice Address - Street 2:SUITE B
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-1305
Practice Address - Country:US
Practice Address - Phone:502-614-7403
Practice Address - Fax:502-410-0447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35882261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain