Provider Demographics
NPI:1053550897
Name:HOSPITALIST ASSOCIATE TEAM
Entity type:Organization
Organization Name:HOSPITALIST ASSOCIATE TEAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:M
Authorized Official - Middle Name:
Authorized Official - Last Name:ADDAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-560-5113
Mailing Address - Street 1:PO BOX 22787
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40252-0787
Mailing Address - Country:US
Mailing Address - Phone:502-713-8714
Mailing Address - Fax:
Practice Address - Street 1:2115 CLUB VISTA PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-5224
Practice Address - Country:US
Practice Address - Phone:513-560-5113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-18
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000620979OtherANTHEM
KY9062366OtherAETNA
KY9062366OtherAETNA
KY000000620979OtherANTHEM