Provider Demographics
NPI:1679927529
Name:UNIVERSITY OF LOUISVILLE
Entity type:Organization
Organization Name:UNIVERSITY OF LOUISVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENCY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-852-5853
Mailing Address - Street 1:530 S. JACKSON STREET
Mailing Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1675
Mailing Address - Country:US
Mailing Address - Phone:502-852-5853
Mailing Address - Fax:
Practice Address - Street 1:530 S. JACKSON STREET
Practice Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1675
Practice Address - Country:US
Practice Address - Phone:502-852-5853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital