Organization
CARITAS PHYSICIAN GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOREE CHING (FINANCE DIRECTOR)
(502) 479-1403
Entity
Organization
Contact information
Practice address
6801 DIXIE HWY, SUITE 134, LOUISVILLE, KY 40258-3913
(502) 937-5888
(502) 937-1237
Mailing address
6801 DIXIE HWY, SUITE 130, LOUISVILLE, KY 40258-3913
(502) 479-1400
(502) 479-1409
Taxonomy
Speciality
Code
Description
License number
State
261QR0206X
Mammography Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000065193
ANTHEM
KY
01
—
2442685000
PASSPORT ADVANTAGE
KY
Enumeration date
11/20/2006
Last updated
08/22/2020
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