Organization
LOUISVILLE-JEFFERSON COUNTY METRO GOVERNMENT
Active
Other names
Louisville Metro Depart of Public Health & Wellness - Specialty 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
914 E BROADWAY STE 102, LOUISVILLE, KY 40204-1184
(502) 574-6699
(502) 574-5922
Mailing address
400 E GRAY ST, P. O. BOX 1704, LOUISVILLE, KY 40202-1740
(502) 574-5652
(502) 574-6417
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
251K000004
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1051423
PASSPORT MANAGED CARE NUM
KY
05
—
20056248
—
KY
Enumeration date
02/22/2007
Last updated
04/22/2024
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