Provider Demographics
NPI:1861583361
Name:VANDIVIER AND ASSOCIATES PSC
Entity type:Organization
Organization Name:VANDIVIER AND ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:VANDIVIER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:502-458-7366
Mailing Address - Street 1:903 BAXTER AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-2046
Mailing Address - Country:US
Mailing Address - Phone:502-458-7366
Mailing Address - Fax:502-458-7362
Practice Address - Street 1:903 BAXTER AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-2046
Practice Address - Country:US
Practice Address - Phone:502-458-7366
Practice Address - Fax:502-458-7362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000060157OtherANTHEM BCBS
KY2812Medicare ID - Type Unspecified