| NPI | 1164572830 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNETTA TRAYLOR Administrator 502-596-6063 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology |
| Additional Taxonomies | 207P00000X Emergency Medicine |
| 207Q00000X Family Medicine | |
| 207R00000X Internal Medicine | |
| 207V00000X Obstetrics & Gynecology | |
| 2085R0202X Radiology, Diagnostic Radiology | |
| 208600000X Surgery | |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2025-06-11 |