Provider Demographics
NPI:1538153309
Name:ST MATTHEWS MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:ST MATTHEWS MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUEFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-895-4263
Mailing Address - Street 1:4003 KRESGE WAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4652
Mailing Address - Country:US
Mailing Address - Phone:502-895-4263
Mailing Address - Fax:502-899-5488
Practice Address - Street 1:4003 KRESGE WAY
Practice Address - Street 2:SUITE 400
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4652
Practice Address - Country:US
Practice Address - Phone:502-895-4263
Practice Address - Fax:502-899-5488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18D0321241291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1066874Medicaid
KY65923682Medicaid
KY3500123OtherUNITED HEALTHCARE REF LAB
KY1538153309Medicare PIN