| NPI | 1073332342 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SOPHIA BERRIOS VP, Provider Process And Services 502-580-1000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2024-10-04 |
| Last Update Date | 2024-10-04 |