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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
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