Organization
PROACTIVE MD KY PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK KEMBLE MD (CMO)
(864) 501-0815
Entity
Organization
Contact information
Practice address
4340 CRITTENDEN DR, LOUISVILLE, KY 40209-1600
(864) 501-0751
Mailing address
124 ALLAWOOD CT, SIMPSONVILLE, SC 29681-6207
(864) 501-0751
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1649359514
NPI
KY
Enumeration date
05/20/2020
Last updated
04/08/2025
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