| NPI | 1265512719 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEVERLY M GAINES President & CEO 502-585-2924 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2019-01-31 |