Organization
LOUISVILLE JEFFERSON COUNTY METRO GOVERNMENT
Active
Other names
Newburg Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ROBYN DICKERSON MSM (FISCAL MANAGER)
(502) 574-6580
Entity
Organization
Contact information
Practice address
4810 EXETER AVE, LOUISVILLE, KY 40218-3874
(502) 458-1215
(502) 456-4812
Mailing address
400 E GRAY ST, P. O. BOX 1704, LOUISVILLE, KY 40202-1740
(502) 574-6514
(502) 574-6417
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
251K000004
KY
251K00000X
Public Health or Welfare Agency
—
—
261QC1500X
Community Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1051422
PASSPORT MANAGED CARE NUM
KY
05
—
20056131
—
KY
Enumeration date
02/23/2007
Last updated
04/22/2024
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