Organization
EAST LOUISVILLE PATHOLOGISTS PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY H MATTHEWS MD (MEDICAL DIRECTOR)
(502) 897-8226
Entity
Organization
Contact information
Practice address
4000 KRESGE WAY, PATHOLOGY DEPT, LOUISVILLE, KY 40207-4605
(502) 897-8226
(502) 897-8215
Mailing address
1169 EASTERN PKWY, SUITE G 71, LOUISVILLE, KY 40217-1417
(502) 456-6217
(502) 456-4440
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000063222
ANTHEM BL CROSS BL SHIELD
KY
01
—
0663153
CIGNA HEALTHCARE
KY
01
—
104509
HEALTH PARTNERS
KY
01
—
1049930
MEDICAID PASSPORT
KY
01
—
1100181
UNITED HEALTHCARE
KY
01
—
124519600
WORKERS COMP FLORIDA
FL
01
—
1527296
UNITED MINE WORKERS
—
01
—
200219150A
MEDICAID INDIANA
IN
01
—
2432719000
PASSPORT ADVANTAGE
KY
05
—
65929226
—
KY
01
—
CE9643
RAILROAD MEDICARE
—
Enumeration date
06/23/2006
Last updated
09/12/2011
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