CHARLES B SHANE MD PSC NPI 1215067780

NPI Information

  • NPI: 1215067780
  • Provider Name: CHARLES B SHANE MD PSC
  • Classification: Obstetrics & Gynecology - 207VG0400X
  • Specialization: Gynecology
  • Entity Type: Organization
  • Address: 4001 KRESGE WAY
    SUITE 315
    LOUISVILLE, KY
    ZIP 40207
  • Phone: (502) 895-7445

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NPI Details

CHARLES B SHANE MD PSC is a gynecology obstetrics gynecology in Louisville, KY. The provider is a physician who specializes in diagnosis, treatment, and management of patients with gynecologic conditions. Source: National Uniform Claim Committee CHARLES B SHANE MD PSC NPI is 1215067780. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4001 KRESGE WAY
SUITE 315
LOUISVILLE, KY
ZIP 40207-640
Phone: (502) 895-7445
Fax: (502) 895-6638

The provider's authorized official is Charles B Shane .
The authorized official title is Owner Physician and has the following contact phone number (502) 895-7445.

The enumeration date for this NPI number is 3/6/2007 and was last updated on 2/24/2009.

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:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207VG0400XObstetrics & GynecologyGynecology18903KENTUCKYYes

Other Identifiers

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

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1000000068700OTHERKENTUCKYANTHEM
264189038MEDICAIDKENTUCKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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