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SKIN GROUP PLLC NPI 1366564494


NPI Information

NPI: 1366564494
Provider Name: SKIN GROUP PLLC
Classification: Dermatology - 207ND0101X
Entity Type: Organization

Specialization: MOHS-Micrographic Surgery

CLIA Number: 18D0934789

Address:
2307 RIVER RD STE 101
LOUISVILLE, KY
ZIP 40206
Phone: (502) 583-6647
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SKIN GROUP PLLC is a mohs-micrographic surgery dermatology in Louisville, KY. The provider is the highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. SKIN GROUP PLLC NPI is 1366564494. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2307 RIVER RD STE 101
LOUISVILLE, KY
ZIP 40206-000
Phone: (502) 583-6647
Fax: (502) 585-4824

The provider's authorized official is Robert H Zax .
The authorized official title is President and has the following contact phone number (502) 583-6647.

The CLIA number assigned to this NPI record is 18D0934789 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 4/6/2007 and was last updated on 2/18/2020.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207ND0101XDermatologyMOHS-Micrographic Surgery25359KENTUCKYYes
2363A00000XPhysician AssistantPA1034KENTUCKYNo
3363L00000XNurse Practitioner4440PKENTUCKYNo

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
165938797MEDICAIDKENTUCKY
2DA0326OTHERKENTUCKYRR MCR
378904968MEDICAIDKENTUCKY
418D0934789OTHERKENTUCKYCLIA NUMBER

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: 11/14/2023

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