Organization
COMMISSION FOR CHILDREN WITH SPECIAL HEALTH CAR
Active
Other names
CCSHCN
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANA L BAKER (BRANCH MANGER PROVIDER RELATIONS)
(502) 429-4430
Entity
Organization
Contact information
Practice address
310 WHITTINGTON PKWY, LOUISVILLE, KY 40222
(502) 429-4430
(502) 429-7160
Mailing address
310 WHITTINGTON PKWY, LOUISVILLE, KY 40222
(502) 429-4430
(502) 429-7160
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000061465
BLUE CROSS AND BLUE SHIEL
KY
05
—
22905616
—
KY
01
—
50000978
PASSPORT ETOWN
KY
01
—
50001443
PASSPORT
KY
Enumeration date
07/12/2005
Last updated
09/07/2010
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