Provider Demographics
NPI:1396791208
Name:LOUISVILLE JEFFERSON COUNTY METRO GOVERNMENT
Entity type:Organization
Organization Name:LOUISVILLE JEFFERSON COUNTY METRO GOVERNMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OMB MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVETTE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-574-6580
Mailing Address - Street 1:834 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1072
Mailing Address - Country:US
Mailing Address - Phone:502-574-4245
Mailing Address - Fax:502-574-4368
Practice Address - Street 1:834 E BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1072
Practice Address - Country:US
Practice Address - Phone:502-574-4245
Practice Address - Fax:502-574-4368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16503416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000247248OtherANTHEM (BC/BS)
KY1056313Medicaid
KY080174000OtherBLACK LUNG
IN100017160AMedicaid
KY2433855000OtherPASSPORT ADVANTAGE
KY55000814Medicaid
KY8281026OtherAETNA
KY000000247248OtherANTHEM (BC/BS)
KY000000247248OtherANTHEM (BC/BS)
KY55000814Medicaid