Provider Demographics
NPI:1760452585
Name:LOUISVILLE MEDICAL CENTER PHYSICIANS INC.
Entity type:Organization
Organization Name:LOUISVILLE MEDICAL CENTER PHYSICIANS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PANSINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-875-3366
Mailing Address - Street 1:1909 WILLIAMSBURG WAY NE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-8781
Mailing Address - Country:US
Mailing Address - Phone:330-875-3366
Mailing Address - Fax:
Practice Address - Street 1:1909 WILLIAMSBURG WAY NE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641-8781
Practice Address - Country:US
Practice Address - Phone:330-875-3366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0694879Medicaid
OH9926291Medicare PIN