Organization
NEPHROLOGY ASSOCIATES OF KENTUCKIANA PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBRA LYNN ROOS CPC (BILLING OFFICE MANAGER)
(502) 587-9660
Entity
Organization
Contact information
Practice address
6400 DUTCHMANS PKWY, SUITE 250, LOUISVILLE, KY 40205-3354
(502) 587-9660
(502) 540-5615
Mailing address
6400 DUTCHMANS PKWY, SUITE 250, LOUISVILLE, KY 40205-3354
(502) 587-9660
(502) 540-5615
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100076180A
—
IN
05
—
1050694
—
KY
01
—
163655200
DEPT OF LABOR GROUP #
KY
01
—
3800
ANTHEM GROUP NUMBER
KY
05
—
65905416
—
KY
05
—
7100237180
—
KY
Enumeration date
11/16/2005
Last updated
08/16/2021
Update your record
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