Organization
UNIVERSITY PATHOLOGISTS, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD J. ELIN MD, PHD (PRESIDENT)
(502) 852-1648
Entity
Organization
Contact information
Practice address
530 S. JACKSON ST., LOUISVILLE, KY 40202
(502) 852-6395
(502) 852-1761
Mailing address
PO BOX 967, LOUISVILLE, KY 40201-0967
(502) 852-1648
(502) 852-2046
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000060193
ANTHEM
KY
01
—
100396660
MEDICAID
IN
05
—
65-922759
—
KY
01
—
8281174
AETNA
KY
01
—
CD3801
RR MEDICARE
KY
Enumeration date
12/23/2005
Last updated
05/02/2008
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