Provider Demographics
NPI:1053485417
Name:CARITAS PHYSICIAN GROUP, INC.
Entity type:Organization
Organization Name:CARITAS PHYSICIAN GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LOREE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-479-1403
Mailing Address - Street 1:6801 DIXIE HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3913
Mailing Address - Country:US
Mailing Address - Phone:502-479-1400
Mailing Address - Fax:502-479-1409
Practice Address - Street 1:6801 DIXIE HWY
Practice Address - Street 2:SUITE 134
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-3913
Practice Address - Country:US
Practice Address - Phone:502-937-5888
Practice Address - Fax:502-937-1237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000065193OtherANTHEM
KY2442685000OtherPASSPORT ADVANTAGE
KY2442685000OtherPASSPORT ADVANTAGE