1386835007 NPI number — UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION, INC.

Table of content: (NPI 1386835007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386835007 NPI number — UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF LOUISVILLE RESEARCH FOUNDATION, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ULRF WINGS CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386835007
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 909
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40201-0909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-588-0320
Provider Business Mailing Address Fax Number:
502-217-5056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 S JACKSON ST
Provider Second Line Business Practice Location Address:
ACB 2ND FLOOR
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-1622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-561-8844
Provider Business Practice Location Address Fax Number:
502-589-5093
Provider Enumeration Date:
08/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GANZEL
Authorized Official First Name:
TONI
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF HEALTH AFFAIRS
Authorized Official Telephone Number:
502-852-5555

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50020689 . This is a "PASSPORT HEALTH PLAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1700115800 (PAS) , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200925390 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 522843 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100083550 (MDS) , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3541914000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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