Provider Demographics
NPI:1730161753
Name:NEPHROLOGY ASSOCIATES OF KENTUCKIANA PSC
Entity type:Organization
Organization Name:NEPHROLOGY ASSOCIATES OF KENTUCKIANA PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ROOS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:502-587-9660
Mailing Address - Street 1:6400 DUTCHMANS PKWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3354
Mailing Address - Country:US
Mailing Address - Phone:502-587-9660
Mailing Address - Fax:502-540-5615
Practice Address - Street 1:6400 DUTCHMANS PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3354
Practice Address - Country:US
Practice Address - Phone:502-587-9660
Practice Address - Fax:502-540-5615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65905416Medicaid
KY163655200OtherDEPT OF LABOR GROUP #
IN100076180AMedicaid
KY3800OtherANTHEM GROUP NUMBER
KY7100237180Medicaid
KY1050694Medicaid
KY163655200OtherDEPT OF LABOR GROUP #
KY163655200OtherDEPT OF LABOR GROUP #
KY2199Medicare PIN
KY7100237180Medicaid