Organization
PARTNERS IN PALLIATIVE CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STACI A MANDROLA MD (SOLE MEMBER)
(502) 693-2681
Entity
Organization
Contact information
Practice address
7504 WESTPORT RD, LOUISVILLE, KY 40222-4108
(502) 693-2681
(502) 495-9738
Mailing address
5672 RELIABLE PARKWAY, CHICAGO, IL 60686-0056
(502) 637-4579
(502) 813-3444
Taxonomy
Speciality
Code
Description
License number
State
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
41139
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000625202
ANTHEM
KY
01
—
3756447000
PASSPORT ADVANTAGE
KY
01
—
50026941
PASSPORT
KY
05
—
7100105330
—
KY
Enumeration date
10/01/2009
Last updated
12/13/2011
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