| Louisville Patient Centered Medical Home, Psc | |
|
4010 Dupont Cir Suite 308 Louisville KY 40207-4812 | |
| (502) 896-8041 | |
| (502) 896-8044 |
| Full Name | Louisville Patient Centered Medical Home, Psc |
|---|---|
| Speciality | Family Medicine |
| Location | 4010 Dupont Cir, Louisville, Kentucky |
| Authorized Official Name and Position | James D. Charasika (PRESIDENT/CEO) |
| Authorized Official Contact | 5028968041 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Louisville Patient Centered Medical Home, Psc 4010 Dupont Cir Suite 308 Louisville KY 40207-4812 Ph: (502) 896-8041 | Louisville Patient Centered Medical Home, Psc 4010 Dupont Cir Suite 308 Louisville KY 40207-4812 Ph: (502) 896-8041 |
| NPI Number | 1265604763 |
|---|---|
| Provider Enumeration Date | 03/25/2008 |
| Last Update Date | 12/27/2013 |
| Medicare PECOS PAC ID | 4688753320 |
|---|---|
| Medicare Enrollment ID | O20080506000436 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265604763 | NPI | - | NPPES |
| 1043299514 | Other | KY | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 18988 (Kentucky) | Primary |
| 261QP2300X | Clinic/center - Primary Care | 18988 (Kentucky) | Secondary |
| Provider Name | James D Charasika |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043299514 PECOS PAC ID: 7315936325 Enrollment ID: I20080506000422 |
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