Provider Demographics
NPI:1386606416
Name:LOUISVILLE GENERAL SURGERY PLLC
Entity type:Organization
Organization Name:LOUISVILLE GENERAL SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-899-6470
Mailing Address - Street 1:4121 DUTCHMANS LN
Mailing Address - Street 2:STE 607
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4707
Mailing Address - Country:US
Mailing Address - Phone:502-899-6470
Mailing Address - Fax:502-899-6479
Practice Address - Street 1:4121 DUTCHMANS LN
Practice Address - Street 2:STE 607
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4707
Practice Address - Country:US
Practice Address - Phone:502-899-6470
Practice Address - Fax:502-899-6479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65928053Medicaid
KY9916Medicare PIN
IN179060Medicare PIN
KY3952Medicare PIN
KY65928053Medicaid
KY9832Medicare PIN