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Active
Organization subpart
No

Provider details

NPI number
Authorized official
DAVID MCDONALD (CHIEF FINANCE OFFICIER)
(502) 596-1039
Entity
Organization

Contact information

Practice address
1100 E MARKET ST., LOUISVILLE, KY 40206
(502) 596-1000
(502) 596-1413
Mailing address
1100 E MARKET ST., LOUISVILLE, KY 40206
(502) 596-1000
(502) 596-1413

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
103TC0700X
Clinical Psychologist
106H00000X
Marriage & Family Therapist
208000000X
Pediatrics Physician
Primary
740143
KY
225100000X
Physical Therapist
101130
KY
225X00000X
Occupational Therapist
101130
KY
235Z00000X
Speech-Language Pathologist
237600000X
Audiologist-Hearing Aid Fitter
251B00000X
Case Management Agency
740143
KY
251S00000X
Community/Behavioral Health Agency
261QR0400X
Rehabilitation Clinic/Center
101130
KY
3140N1450X
Pediatric Skilled Nursing Facility
100493
KY
363LP0200X
Pediatric Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
12500989
KY
05
201015150A
IN
05
300031860
IN
05
65902470
KY
05
7100156180
KY
05
7100173100
KY
05
7100229960
KY
05
7100268020
KY
05
7100275730
KY
05
7100281540
KY
05
7100305090
KY
05
7100315940
KY
Enumeration date
05/23/2006
Last updated
04/24/2025
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