Provider Demographics
NPI:1992747794
Name:JARVIS, PATRICK M (MD)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:M
Last Name:JARVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:200 E CHESTNUT ST STE 303
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1831
Practice Address - Country:US
Practice Address - Phone:502-629-5552
Practice Address - Fax:502-629-3132
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34908208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000332130OtherANTHEM
KY3690745000OtherPASSPORT ADVANTAGE- NORTON INPATIENT SPECIALISTS
KY7694550OtherAETNA PPO
KY000000587287OtherANTHEM- NORTON INPATIENT SPECIALISTS
KY64057029Medicaid
KY000023034POtherHUMANA- NORTON INPATIENT SPECIALISTS
KY099258OtherSIHO- NORTON INPATIENT SPECIALISTS
KY200399030OtherHEALTHY INDIANA PLAN- NORTON INPATIENT SPECIALISTS
KY3426812OtherAETNA HMO ONLY
KY200399030OtherMD WISE- NORTON INPATIENT SPECIALISTS
KY50020903OtherPASSPORT- NORTON INPATIENT SPECIALISTS
KY200399030OtherANTHEM INDIANA MEDICAID- NORTON INPATIENT SPECIALISTS
KY2234475OtherUNITED HEALTH CARE
KY64057029OtherMEDICAID KY- NORTON INPATIENT SPECIALISTS
2179941OtherFIRST HEALTH
KY2446133000OtherPASSPORT ADVANTAGE
KY4130645OtherCIGNA- NORTON INPATIENT SPECIALISTS
4130645OtherCIGNA
IN200399030OtherMEDICAID- NORTON INPATIENT SPECIALISTS
KY50004781OtherPASSPORT
KYP00655702OtherRAILROAD MEDICARE- NORTON INPATIENT SPECIALISTS
KY00533072OtherMEDICARE- NORTON INPATIENT SPECIALISTS
IN200399030Medicaid
KY000000332130OtherANTHEM
IN200399030OtherMEDICAID- NORTON INPATIENT SPECIALISTS
IN200399030Medicaid