# LOUISVILLE PATIENT CENTERED MEDICAL HOME, PSC

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

## Provider details

- **NPI number:** 1265604763
- **Authorized official:** DR. JAMES D. CHARASIKA M.D. (PRESIDENT/CEO)
- **Authorized official phone:** (502) 896-8041

## Contact information

- **Practice address:** 4010 DUPONT CIR, SUITE 308, LOUISVILLE, KY 40207-4812
- **Practice address phone:** (502) 896-8041
- **Practice address fax:** (502) 896-8044
- **Mailing address:** 4010 DUPONT CIR, SUITE 308, LOUISVILLE, KY 40207-4812
- **Mailing address phone:** (502) 896-8041
- **Mailing address fax:** (502) 896-8044

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 18988 | KY | Yes |
| 261QP2300X | Primary Care Clinic/Center | 18988 | KY | — |

## Other

- **Enumeration date:** 03/25/2008
- **Last updated:** 12/27/2013