Provider Demographics
NPI:1316318066
Name:HOSPARUS, INC.
Entity type:Organization
Organization Name:HOSPARUS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-719-4140
Mailing Address - Street 1:3532 EPHRAIM MCDOWELL DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3224
Mailing Address - Country:US
Mailing Address - Phone:502-456-6200
Mailing Address - Fax:502-456-6275
Practice Address - Street 1:3532 EPHRAIM MCDOWELL DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3224
Practice Address - Country:US
Practice Address - Phone:502-456-6200
Practice Address - Fax:502-456-6275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1052380Medicaid
KY44056018Medicaid
KY1052380Medicaid
KY181502Medicare Oscar/Certification