Provider Demographics
NPI:1528118890
Name:LOUISVILLE ENT ASSOCIATES
Entity type:Organization
Organization Name:LOUISVILLE ENT ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BRUMITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-459-3760
Mailing Address - Street 1:2355 POPLAR LEVEL RD
Mailing Address - Street 2:400
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1395
Mailing Address - Country:US
Mailing Address - Phone:502-459-3760
Mailing Address - Fax:502-459-3717
Practice Address - Street 1:2355 POPLAR LEVEL RD
Practice Address - Street 2:400
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1395
Practice Address - Country:US
Practice Address - Phone:502-459-3760
Practice Address - Fax:502-459-3717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24518207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2653Medicare ID - Type Unspecified