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Organization
A BERT SPARROW PSC
Active
Organization
A BERT SPARROW PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ATHEL BERT SPARROW M.D. (PRESIDENT)
(502) 361-6075
Entity
Organization
Contact information
Practice address
4402 CHURCHMAN AVE, STE 211, LOUISVILLE, KY 40215-3100
(502) 361-6075
(502) 361-6071
Mailing address
4402 CHURCHMAN AVE, STE 211, LOUISVILLE, KY 40215-3100
(502) 361-6075
(502) 361-6071
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
13980
KY
2086S0129X
Vascular Surgery Physician
Primary
13980
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000045552
BLUE CROSS BLUE SHIELD
—
01
—
022087143
RAILROAD MEDICARE
KY
05
—
100003430 A
—
IN
01
—
1048991
PASSPORT
KY
01
—
2432327000
PASSPORT ADVANTAGE
KY
05
—
65934580
—
KY
Enumeration date
07/03/2006
Last updated
04/24/2008
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