Organization
UNIVERSITY PHYSICIAN ASSOCIATES
Active
Other names
UPA Urology
Organization subpart
No
Provider details
NPI number
Authorized official
PAM ANDERSON (CHIEF FINANCIAL OFFICER)
(502) 562-5762
Entity
Organization
Contact information
Practice address
550 S JACKSON ST, 2ND FLOOR, LOUISVILLE, KY 40202-1622
(502) 562-6511
(502) 562-6512
Mailing address
501 E BROADWAY, STE 290, LOUISVILLE, KY 40202-1785
(502) 217-8221
(502) 217-5056
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000552733
ANTHEM
—
05
—
31000102
—
KY
01
—
50006485
PASSPORT HEALTH PLAN
KY
Enumeration date
07/07/2006
Last updated
05/19/2010
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