Provider Demographics
NPI:1316767874
Name:ATHENA HEALTH CORP
Entity type:Organization
Organization Name:ATHENA HEALTH CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PR
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:URQUIZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-484-3984
Mailing Address - Street 1:1930 BISHOP LN STE 130A
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1921
Mailing Address - Country:US
Mailing Address - Phone:305-484-3984
Mailing Address - Fax:
Practice Address - Street 1:1930 BISHOP LN STE 130A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1921
Practice Address - Country:US
Practice Address - Phone:305-484-3984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care