Provider Demographics
NPI:1386848836
Name:JOHN E. GALLEHR, MD P.S.C.
Entity type:Organization
Organization Name:JOHN E. GALLEHR, MD P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:GALLEHR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-727-7759
Mailing Address - Street 1:8013 NEW LAGRANGE RD
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4700
Mailing Address - Country:US
Mailing Address - Phone:502-727-7759
Mailing Address - Fax:
Practice Address - Street 1:8013 NEW LAGRANGE RD
Practice Address - Street 2:SUITE # 1
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4700
Practice Address - Country:US
Practice Address - Phone:502-727-7759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29766261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65932303Medicaid
KYG24744Medicare UPIN