Organization
CORPORATE HEALTH CARE PSC
Active
Other names
Lyndon Family Medicine PSC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACOB BLUM MD (PRESIDENT)
(502) 425-9930
Entity
Organization
Contact information
Practice address
8013 NEW LAGRANGE RD, SUITE #5, LOUISVILLE, KY 40222-4700
(502) 425-9930
(502) 425-0915
Mailing address
8013 NEW LAGRANGE RD, SUITE #5, LOUISVILLE, KY 40222-4700
(502) 425-9930
(502) 425-0915
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
28306
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720047137
NPI INDIVIDUAL PROVIDER
KY
Enumeration date
07/03/2007
Last updated
08/22/2020
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