Organization
KOMG-LOUISVILLE REGION INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD E. WALDRIDGE MD (PRESIDENT/PHYSICIAN EXECUTIVE)
(502) 210-6010
Entity
Organization
Contact information
Practice address
201 ABRAHAM FLEXNER WAY, LOUISVILLE, KY 40202-3841
(502) 259-6010
Mailing address
100 E LIBERTY ST STE 800, LOUISVILLE, KY 40202-1428
(502) 540-3339
(502) 540-3393
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
2081H0002X
Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
11/14/2018
Last updated
01/30/2019
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