Provider Demographics
NPI:1699725598
Name:KENTUCKIANA PULMONARY ASSOCIATES, PLLC
Entity type:Organization
Organization Name:KENTUCKIANA PULMONARY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-587-8000
Mailing Address - Street 1:PO BOX 950154 DEPT 52937
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0154
Mailing Address - Country:US
Mailing Address - Phone:502-587-8000
Mailing Address - Fax:502-583-8001
Practice Address - Street 1:100 W MARKET ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1332
Practice Address - Country:US
Practice Address - Phone:502-587-8000
Practice Address - Fax:502-583-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200203050Medicaid
KY65930935Medicaid
CI3617Medicare PIN
IN084750Medicare ID - Type Unspecified
KY65930935Medicaid