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Organization

DERMATOLOGY ASSOCIATES , PSC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ANNIE WHITEHOUSE (ADMINISTRATION)
(502) 896-6355
Entity
Organization

Contact information

Practice address
2811 KLEMPNER WAY, LOUISVILLE, KY 40205
(502) 896-6355
(502) 896-6357
Mailing address
PO BOX 950266, LOUISVILLE, KY 40295-0266
(502) 896-6355
(502) 896-6357

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1090732
PASSPORT
KY
01
2435933000
PASSPORT ADVANTAGE
KY
01
4884
MEDICARE
KY
05
65921173
KY
01
CL4950
MEDICARE RAIL ROAD
KY
Enumeration date
06/29/2005
Last updated
06/09/2020
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