Provider Demographics
NPI:1649366196
Name:LOUISVILLE COLORECTAL ASSOCIATES LLC
Entity type:Organization
Organization Name:LOUISVILLE COLORECTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOWELL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-584-6666
Mailing Address - Street 1:250 E LIBERTY ST
Mailing Address - Street 2:SUITE 610
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1536
Mailing Address - Country:US
Mailing Address - Phone:502-584-6666
Mailing Address - Fax:502-589-6342
Practice Address - Street 1:250 EAST LIBERTY STREET
Practice Address - Street 2:SUITE 610
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1536
Practice Address - Country:US
Practice Address - Phone:502-584-6666
Practice Address - Fax:502-589-6342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16857208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65932006Medicaid
KY1048817OtherPASSPORT
KY2432234000OtherPASSPORT ADVANTAGE
KY65932006Medicaid
KY2432234000OtherPASSPORT ADVANTAGE
KY1048817OtherPASSPORT