Organization
S RANDOLPH SCHEEN III MD PSC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL RANDOLPH SCHEEN III MD (OWNER)
(502) 893-1645
Entity
Organization
Contact information
Practice address
4121 DUTCHMANS LANE, SUITE 401, LOUISVILLE, KY 40207
(502) 893-1645
(502) 897-2338
Mailing address
4121 DUTCHMANS LANE, SUITE 401, LOUISVILLE, KY 40207
(502) 893-1645
(502) 897-2338
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
21343
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000358728
ANTHEM
—
01
—
P00204656 DD0297
RR MEDICARE
—
Enumeration date
01/26/2007
Last updated
08/22/2020
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