| Pearl Medical Practice Pllc | |
|
4200 Gardiner View Ave Suite 200 Louisville KY 40213-1877 | |
| (502) 456-0494 | |
| (502) 456-0496 |
| Full Name | Pearl Medical Practice Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4200 Gardiner View Ave, Louisville, Kentucky |
| Authorized Official Name and Position | Osawaru Omoruyi (PRESIDENT) |
| Authorized Official Contact | 5024560494 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pearl Medical Practice Pllc 4200 Gardiner View Ave Suite 200 Louisville KY 40213-1877 Ph: (502) 456-0494 | Pearl Medical Practice Pllc 4200 Gardiner View Ave Suite 200 Louisville KY 40213-1877 Ph: (502) 456-0494 |
| NPI Number | 1114261203 |
|---|---|
| Provider Enumeration Date | 11/15/2012 |
| Last Update Date | 10/02/2015 |
| Medicare PECOS PAC ID | 1951547108 |
|---|---|
| Medicare Enrollment ID | O20130415000186 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114261203 | NPI | - | NPPES |
| 7100267920 | Medicaid | KY | |
| 7100259660 | Medicaid | KY |
| Provider Name | Lori Elizabeth Weis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568405942 PECOS PAC ID: 4284526047 Enrollment ID: I20040326000429 |
| Provider Name | Osawaru Jude Omoruyi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396961967 PECOS PAC ID: 8921190992 Enrollment ID: I20090325000174 |
| Provider Name | Smita Ranjan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831478114 PECOS PAC ID: 8224202023 Enrollment ID: I20111112000044 |
| Provider Name | Oliver E Olson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255696597 PECOS PAC ID: 5991953671 Enrollment ID: I20120921000538 |
| Provider Name | Mark Harris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538542816 PECOS PAC ID: 4789998022 Enrollment ID: I20150730014064 |
| Provider Name | Vicky L. Raisor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194181289 PECOS PAC ID: 9335441096 Enrollment ID: I20160112002322 |
| Provider Name | Virginia A Bonnette |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316041445 PECOS PAC ID: 3870592678 Enrollment ID: I20200114001079 |
| Provider Name | Naomi Jean Eisenback |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417513029 PECOS PAC ID: 4082042957 Enrollment ID: I20200309001219 |
| Provider Name | Rachael P. Abell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992339345 PECOS PAC ID: 9032547476 Enrollment ID: I20200317001941 |
| Provider Name | Chioma C Holland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730788621 PECOS PAC ID: 5092125179 Enrollment ID: I20201030000461 |
| Provider Name | Joni Marie Miles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265102941 PECOS PAC ID: 7719375757 Enrollment ID: I20211025002999 |
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