Organization
ON-SITE DERMATOLOGY CONSULTANTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA C. MADER ARNP (PRESIDENT)
(502) 322-6678
Entity
Organization
Contact information
Practice address
11209 VISTA GREENS DR, LOUISVILLE, KY 40241-3444
(502) 322-6678
(502) 394-0086
Mailing address
11209 VISTA GREENS DR, LOUISVILLE, KY 40241-3444
(502) 322-6678
(502) 394-0086
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4150P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000484649
ANTHEM
KY
05
—
78905320
—
KY
01
—
DF3020
RAILROAD MEDICARE
KY
Enumeration date
07/21/2006
Last updated
04/20/2008
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