# SOUTH OLDHAM MEDICAL CLINIC PSC

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

## Provider details

- **NPI number:** 1922142983
- **Authorized official:** ASHOR ALUR MD (PHYSICIAN OWNER)
- **Authorized official phone:** (502) 241-8488

## Contact information

- **Practice address:** 6520 W HWY 22, CRESTWOOD, KY 40014
- **Practice address phone:** (502) 241-8488
- **Practice address fax:** (502) 241-7424
- **Mailing address:** 6520 W HWY 22, CRESTWOOD, KY 40014
- **Mailing address phone:** (502) 241-8488
- **Mailing address fax:** (502) 241-7424

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 30373 | KY | Yes |

## Other

- **Enumeration date:** 02/16/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 64303738 | — | KY |