CLEANSLATE MEDICAL GROUP OF KENTUCKY PLLC (NPI# 1538600630) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538600630 |
| Entity Type | Organization |
| Organization Name | CLEANSLATE MEDICAL GROUP OF KENTUCKY PLLC |
| Practice Address |
210 E Gray St Ste 803 Louisville KY 40202-3904 |
| Mailing Address |
15 Century Blvd Ste 307 Nashville TN 37214-3692 |
| Practice Telephone | 5022389462 |
| Mailing Telephone | 6154250220 |
| Enumeration Date | 2017-03-09 |
| Last Update Date | 2019-07-02 |
| Authorized Official Name | ROBERT HUTCHISON (CFO) |
| Authorized Official Telephone | 6154250220 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RA0401X |
Internal Medicine Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians |
| Street Address |
210 E GRAY ST STE 803 |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40202-3904 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972129682 | Garvit Chhabra | Student in an Organized Health Care Education/Training Program | 550, South Jackson Street, Acb, Third Floor, Louisville, KY 40202 | 2020-06-18 |
| 1396367009 | Richele Williams | Student in an Organized Health Care Education/Training Program | 201 Abraham Flexner Way Department of Family and Pediac, Suite 690, Louisville, KY 40202 | 2020-05-15 |
| 1942822028 | Ahmed Khaled Saleh | Student in an Organized Health Care Education/Training Program | 500 S Jackson St, Room 305, Louisville, KY 40202 | 2020-05-12 |
| 1457972952 | Mir Ali Raza Talpur | Student in an Organized Health Care Education/Training Program | 401 E Chestnut Street, Suite 600 University of Louisvi, Louisville, KY 40202 | 2020-05-06 |
| 1316575533 | Abigail Hatfield | Student in an Organized Health Care Education/Training Program | Internal Medicine Training Program, 550 South Jackson Street, Acb 3rd Floor, Louisville, KY 40202 | 2020-04-01 |
| 1851929210 | Madison Harmon | Student in an Organized Health Care Education/Training Program | Uofl Department of Emergency Medicine, 530 S. Jackson Street Room C1h17, Louisville, KY 40202 | 2020-03-31 |
| 1184252041 | Marianna Weaver | Student in an Organized Health Care Education/Training Program | 550 South Jackson Street, Acb 3rd Floor, University of Louisville, Louisville, KY 40202 | 2020-03-27 |
| 1700347341 | Charles Jake Sadle | Student in an Organized Health Care Education/Training Program | Office of Medical Education C/o Brittney Luckett, 571 S. Floyd St., Ste. 412, Louisville, KY 40202 | 2019-03-27 |
| 1437616794 | Paladina Health, LLC | Family Medicine | Paladina Health Humana East, 123 E Main Street, Louisville, KY 40202 | 2019-02-22 |
| 1205393568 | Paladina Health, LLC | Family Medicine | Paladina Health Humana West, 500 W Main Street, Louisville, KY 40202 | 2019-02-22 |
| Find all providers in zip 40202 | ||||
| Taxonomy Code | 207RA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Addiction Medicine |
| An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083093207 | Mat Prac Group, LLC | Internal Medicine | 204 S Floyd St, Box 8, Louisville, KY 40202-1208 | 2015-05-20 |
| 1194140772 | Stephanie Prater Walton | Internal Medicine | 14607 Woodlake Trce, Louisville, KY 40245-5134 | 2014-02-19 |
| 1376547711 | Irwin Randell Cohen | Internal Medicine | 4006 Dutchmans Ln, Suite 100, Louisville, KY 40207-4704 | 2005-06-13 |
| 1831388073 | Jonathan D Kunis | Internal Medicine | 10101 Linn Station Rd Ste 600, Louisville, KY 40223-3818 | 2007-10-23 |
| 1497973366 | Robert Joseph Middleton | Internal Medicine | 2100 Gardiner Ln, Ste 217a, Louisville, KY 40205-2962 | 2007-04-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326671637 | Discover Recovery, LLC | Internal Medicine | 2413 Ring Rd Ste 122, Elizabethtown, KY 42701-5936 | 2020-02-14 |
| 1033618897 | Lotus Rehab LLC | Internal Medicine | 104 Hardin Ln Ste B, Somerset, KY 42503-3800 | 2018-02-07 |
| 1396265989 | Kentucky Ohanna Initiative, Inc | Internal Medicine | 1795 Alysheba Way Ste 1001, Lexington, KY 40509-2282 | 2017-06-23 |
| 1457580003 | Thomas William Howard, IIi | Internal Medicine | 135 E Maxwell St Ste 401, Lexington, KY 40508-2617 | 2009-07-03 |
| 1477562536 | Sanjiv Gupta M.d. P.s.c. | Internal Medicine | 300 St Hwy 1947, Suite A, Grayson, KY 41143-1947 | 2006-08-07 |
| 1578533766 | Marvin A Bishop | Internal Medicine | 218 S Maple St, Winchester, KY 40391-2494 | 2006-01-23 |
| 1700870078 | Joanna L Santiesteban | Internal Medicine | 842 E Mountain Pkwy, Salyersville, KY 41465 | 2005-09-01 |
| 1184221038 | Compass Investments, LLC | Internal Medicine | 1616 Harrodsburg Rd, Lexington, KY 40504-3706 | 2020-10-05 |
| 1447793872 | Jessica Michelle Marshal | Internal Medicine | 1740 Nicholasville Rd, 4th Floor, Lexington, KY 40503-1431 | 2016-12-03 |
| 1477915056 | Anna Maria South | Internal Medicine | 800 Rose St, Lexington, KY 40536-0001 | 2016-03-23 |
| Find all providers with the same taxonomy | ||||
| City | LOUISVILLE |
| Zip Code | 40202 |
Please comment or provide details below to improve the information on CLEANSLATE MEDICAL GROUP OF KENTUCKY PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.