Organization
COMMONWEALTH OF KENTUCKY
Active
Parent organization
COMMONWEALTH OF KENTUCKY
Other names
Hazelwood Specialty Clinic, Hazelwood Specialty Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMONWEALTH OF KENTUCKY
Authorized official
JENNIFER MOORE (ASSISTANT DIRECTOR)
(502) 782-6117
Entity
Organization
Contact information
Practice address
1800 BLUEGRASS AVE, LOUISVILLE, KY 40215-1130
(502) 361-2301
(502) 366-0367
Mailing address
1800 BLUEGRASS AVE, LOUISVILLE, KY 40215-1130
(502) 361-2301
(502) 366-0367
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
04/15/2014
Last updated
08/07/2024
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