Organization
SHAWNEE CHRISTIAN HEALTHCARE CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIRSTIE MATZEK MD (PRESIDENT)
(502) 778-0001
Entity
Organization
Contact information
Practice address
234 AMY AVE, LOUISVILLE, KY 40212-2522
(502) 778-0001
Mailing address
234 AMY AVE, LOUISVILLE, KY 40212-2522
(502) 778-0001
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
1223G0001X
General Practice Dentistry
—
—
207R00000X
Internal Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
LAL000152
KY
363A00000X
Physician Assistant
—
—
363LA2100X
Acute Care Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100150090
—
KY
Enumeration date
01/13/2011
Last updated
08/07/2024
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