# DIXIE PRIMARY CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053645572
- **Authorized official:** DR. VICTOR SHPILBERG MD (OWNER)
- **Authorized official phone:** (502) 937-3155

## Contact information

- **Practice address:** 8033 DIXIE HWY, LOUISVILLE, KY 40258-1344
- **Practice address phone:** (502) 937-3155
- **Practice address fax:** (502) 935-0743
- **Mailing address:** 8033 DIXIE HWY, LOUISVILLE, KY 40258-1344
- **Mailing address phone:** (502) 937-3155
- **Mailing address fax:** (502) 935-0743

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 09/30/2009
- **Last updated:** 01/11/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 18D1106923 | CLIA | KY |