Provider Demographics
NPI:1154719797
Name:HEUSER HEALTH & FITNESS CENTER, LLC
Entity type:Organization
Organization Name:HEUSER HEALTH & FITNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:JANSON
Authorized Official - Last Name:HEUSER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:502-893-7833
Mailing Address - Street 1:1860 MELLWOOD AVE # 197
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1033
Mailing Address - Country:US
Mailing Address - Phone:502-893-7833
Mailing Address - Fax:502-895-4418
Practice Address - Street 1:1860 MELLWOOD AVE # 197
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1033
Practice Address - Country:US
Practice Address - Phone:502-893-7833
Practice Address - Fax:502-895-4418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Multi-Specialty