SHAWNEE CHRISTIAN HEALTHCARE CENTER INC NPI 1225333743

NPI Information

NPI: 1225333743
Provider Name: SHAWNEE CHRISTIAN HEALTHCARE CENTER INC
Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

CLIA Number: 18D2020810

Address:
234 AMY AVE
LOUISVILLE, KY
ZIP 40212
Phone: (502) 778-0001
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SHAWNEE CHRISTIAN HEALTHCARE CENTER INC is a federally qualified health center (fqhc) clinic center in Louisville, KY. SHAWNEE CHRISTIAN HEALTHCARE CENTER INC NPI is 1225333743. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

234 AMY AVE
LOUISVILLE, KY
ZIP 40212-522
Phone: (502) 778-0001

The provider's authorized official is David A Dageforde .
The authorized official title is President and has the following contact phone number (502) 645-6817.

The CLIA number assigned to this NPI record is 18D2020810 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/13/2011 and was last updated on 6/16/2016.

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
1	207R00000X	Internal Medicine				No
2	363LA2100X	Nurse Practitioner	Acute Care			No
3	363LP0200X	Nurse Practitioner	Pediatrics			No
4	101YP2500X	Counselor	Professional			No
5	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)	LAL000152	KENTUCKY	Yes

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
1	P100038803	MEDICARE PIN	KENTUCKY
2	7100150090	MEDICAID	KENTUCKY

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: 4/28/2024

NPI Synchronization or Removal

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