Provider Demographics
NPI:1144491408
Name:CHEST MEDICINE ASSOCIATES PSC
Entity type:Organization
Organization Name:CHEST MEDICINE ASSOCIATES PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOATWRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-454-0269
Mailing Address - Street 1:1169 EASTERN PKWY
Mailing Address - Street 2:SUITE 2266
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1417
Mailing Address - Country:US
Mailing Address - Phone:502-238-3178
Mailing Address - Fax:502-238-3653
Practice Address - Street 1:313 FEDERAL DR NW
Practice Address - Street 2:SUITE 10
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-3070
Practice Address - Country:US
Practice Address - Phone:502-459-9127
Practice Address - Fax:502-459-2956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207R00000X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1144491408OtherNPI
IN100004470Medicaid
IN258300Medicare UPIN