Provider Demographics
NPI:1306341417
Name:LOUISVILLE PRIMARY CARE
Entity type:Organization
Organization Name:LOUISVILLE PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOENBAECHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-220-8437
Mailing Address - Street 1:801 BARRET AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1732
Mailing Address - Country:US
Mailing Address - Phone:502-200-8259
Mailing Address - Fax:502-584-8379
Practice Address - Street 1:801 BARRET AVE STE 112
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1732
Practice Address - Country:US
Practice Address - Phone:502-200-8259
Practice Address - Fax:502-584-8379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty