Organization
UMA PRIMARY CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSE ROMAN MD (PRESIDENT)
(502) 852-5241
Entity
Organization
Contact information
Practice address
401 E CHESTNUT ST, #370, LOUISVILLE, KY 40202-5700
(502) 562-6510
(502) 562-6515
Mailing address
501 E BROADWAY, #290, LOUISVILLE, KY 40202-1785
(502) 217-8221
(502) 217-5056
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50020522
PASSPORT HEALTH PLAN
KY
05
—
7100050240 (MDS)
—
KY
05
—
7100106840 (ARNPS)
—
KY
Enumeration date
07/10/2008
Last updated
07/08/2010
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