Organization
UPA NEUROSURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS KELLY (VP OF OPERATIONS)
(502) 217-5120
Entity
Organization
Contact information
Practice address
550 S JACKSON ST, 1ST FLOOR, LOUISVILLE, KY 40202-1622
(502) 562-6501
(502) 562-6502
Mailing address
501 E BROADWAY, STE 290, LOUISVILLE, KY 40202-1785
(502) 217-5134
(502) 217-5056
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31000102
—
KY
Enumeration date
11/01/2011
Last updated
11/01/2011
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