Provider Demographics
NPI:1538738000
Name:LOUISVILLE OCCUPATIONAL AND GENERAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:LOUISVILLE OCCUPATIONAL AND GENERAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:L
Authorized Official - Last Name:ESEME
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:502-890-5037
Mailing Address - Street 1:4814 PRESTON HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-2235
Mailing Address - Country:US
Mailing Address - Phone:502-890-5037
Mailing Address - Fax:502-384-2104
Practice Address - Street 1:4814 PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-2235
Practice Address - Country:US
Practice Address - Phone:502-890-5037
Practice Address - Fax:502-384-2104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Multi-Specialty