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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JASON DANIEL BRICE (OWNER)
(502) 409-1308
Entity
Organization

Contact information

Practice address
136 N CRESTMOOR AVE, LOUISVILLE, KY 40206-2735
(502) 409-1308
Mailing address
136 N CRESTMOOR AVE, LOUISVILLE, KY 40206-2735
(502) 409-1308

Taxonomy

Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary

Other

Enumeration date
11/19/2010
Last updated
11/19/2010
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Product
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  • Eligibility checks
  • EDI platform