PROACTIVE MD KY PSC (NPI# 1548883960) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548883960 |
| Entity Type | Organization |
| Organization Name | PROACTIVE MD KY PSC |
| Practice Address |
4340 Crittenden Dr Louisville KY 40209-1600 |
| Mailing Address |
10 Centimeters Dr Mauldin SC 29662-3278 |
| Practice Telephone | 8645010751 |
| Mailing Telephone | 8645010751 |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2020-08-04 |
| Authorized Official Name | MARK KEMBLE (DIRECTOR OF MEDICAL AFFAIRS) |
| Authorized Official Telephone | 8645010815 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | NPI | 1649359514 | 01 |
| Street Address |
4340 CRITTENDEN DR |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40209-1600 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821124660 | Occupational Health Centers of The Southwest, P.a., P.s.c. | Clinic/Center | 4870 Crittenden, Louisville, KY 40209 | 2007-02-26 |
| 1184873119 | Concentra Health Services, Inc. | Clinic/Center | 4870 Crittenden, Louisville, KY 40209 | 2008-09-15 |
| 1740606078 | Vickie Cobble-forehand | Home Health Aide | 215 Ottawa Ave, Louisville, KY 40209-1212 | 2014-03-11 |
| 1932263035 | Michael Childers | Dentist | 644 Phillips Ln, Suite 1002, Louisville, KY 40209-1312 | 2006-12-21 |
| 1245200419 | Mercy Ambulance Service, Inc. | Ambulance | 468 Huron Ave, Louisville, KY 40209-1626 | 2006-01-23 |
| 1063695567 | American Current Care, P.a. | Clinic/Center | 4870 Crittenden Dr, Louisville, KY 40209-1702 | 2007-12-07 |
| 1881951564 | Nora Richardson | Physical Therapist | 4870 Crittenden Dr, Louisville, KY 40209-1732 | 2012-04-18 |
| 1043606882 | Krystal Gomez | Specialist/Technologist | 2432 S Floyd St, Louisville, KY 40209-1805 | 2015-04-08 |
| 1467803163 | Fred Wynn Hina Jr. | Specialist/Technologist | 2432 S Floyd St, Louisville, KY 40209-1805 | 2016-06-24 |
| 1578063525 | Jeremy William Dockter | Specialist/Technologist | 2800 S Floyd St, Louisville, KY 40209-1818 | 2018-02-16 |
| Find all providers in zip 40209 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| 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. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1639636988 | Paladina Health, LLC | Family Medicine | Paladina Health Louisville Park Plaza, 9720 Park Plaza Avenue #101, Louisville, KY 40241 | 2019-02-22 |
| 1619434974 | Paladina Health, LLC | Family Medicine | Paladina Health Louisville Centerstone Broadway, 914 East Broadway Suite 200, Louisville, KY 40204 | 2019-02-22 |
| 1558844027 | Arthur James Shulthise Jr. | Family Medicine | Bldg. 2801 - Bowman Field, 2801 Taylorsville Road, Louisville, KY 40205 | 2018-09-11 |
| 1104341171 | Brandy Wells | Family Medicine | 11612 Top Walnut Loop, Louisville, KY 40229 | 2017-08-10 |
| 1437679842 | Michael Edward Lovelace | Family Medicine | 1800 Stevens Avenue, Louisville, KY 40205 | 2017-06-27 |
| 1770939043 | Rss Inc Dba Mediweightloss | Family Medicine | 166 N Hurstbourne Pkwy, Louisville, KY 40222-5108 | 2016-05-05 |
| 1104280379 | Jonathan Paul Newsom | Family Medicine | 2401 Terra Crossing Blvd Ste 101, Louisville, KY 40245-5371 | 2016-04-13 |
| 1194187278 | Sarah Ruth Nester | Family Medicine | 9880 Angies Way Ste 410, Louisville, KY 40241-2850 | 2016-03-28 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 40209 |
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| 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.