PROACTIVE MD KY PSC NPI 1548883960

NPI Information

PROACTIVE MD KY PSC is a family medicine in Louisville, KY. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. PROACTIVE MD KY PSC NPI is 1548883960. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

4340 CRITTENDEN DR
LOUISVILLE, KY
ZIP 40209-600
Phone: (864) 501-0751

The provider's authorized official is Ben Stoner .
The authorized official title is Evp Finance & Administration and has the following contact phone number (864) 501-0815.

The CLIA number assigned to this NPI record is 42D2177402 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/20/2020 and was last updated on 5/1/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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