DR. JACK DALE TOLLIVER JR. (NPI# 1891155024) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891155024 |
| Entity Type | Individual |
| Full Name | DR. JACK DALE TOLLIVER JR. |
| Credential | M.D. |
| Practice Address |
2120 Cave Spring Pl Louisville KY 40223-1562 |
| Practice Telephone | 5029311373 |
| Mailing Telephone | 5029311373 |
| Enumeration Date | 2016-03-01 |
| Last Update Date | 2016-03-01 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 173000000X | Legal Medicine | 21479 | KY | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | KENTUCKY BOARD OF MEDICAL LICENSURE | 21479 | 01 |
| Street Address |
2120 CAVE SPRING PL |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40223-1562 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235605668 | Ashlee Brooke Colville | Counselor | 13121 Esat Point Park Blvd, Suite F, Louisville, KY 40223 | 2018-10-24 |
| 1831619758 | Tracie S Lain | Developmental Therapist | 13101 Eastpoint Park Blvd., Louisville, KY 40223 | 2017-06-21 |
| 1972051399 | Ruby Denise Brooks | Counselor | 1407 Lafontenay Ct, Louisville, KY 40223 | 2016-09-14 |
| 1427409085 | Victoria Krepps Terrell | Nurse Practitioner | 13301 Shelbyville Rd Ste 103, Louisville, KY 40223 | 2016-06-24 |
| 1033570098 | Mackenzie Sipes | Chiropractor | 401 Creason Ct Unit 205, Louisville, KY 40223 | 2016-03-17 |
| 1699151258 | Chelsey Layne Gorham | Marriage & Family Therapist | 13121 Eastpoint Park Blvd Ste F, Louisville, KY 40223 | 2015-08-06 |
| 1356764187 | Paula Renee Garner | Social Worker | 1015 Dorsey Lane, Louisville, KY 40223 | 2014-01-30 |
| 1588086508 | Lori Bettenhausen Williams | Ophthalmology | 1413 Evergreen Rd, Anchorage, KY 40223 | 2014-01-09 |
| 1417392259 | Lauren Parsons Berry | Dentist | 9780 Ormsby Station Rd, Suite 1200, Louisviile, KY 40223 | 2013-05-07 |
| 1336486653 | Lynn M Pendley | Dietitian, Registered | 9400 Mill Brook Rd, Northeast Ymca, Louisville, KY 40223 | 2013-01-07 |
| Find all providers in zip 40223 | ||||
| Taxonomy Code | 173000000X |
| Grouping | Other Service Providers |
| Classification | Legal Medicine |
| The specialty areas of medicine concerned with matters of, and relations with, substantive law and legal institutions; such as the conduct of medical examinations at crime scenes, performance of autopsies, giving of expert medical testimony in judicial proceedings, medical treatment of inmates of penal institutions, the practice of trauma medicine in law enforcement settings, and other clinical practice and medical science applications in the fields of law, law enforcement, and corrections. |
| Notes: Source: Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073660577 | George R Nichols II | Legal Medicine | 6013 Brownsboro Park Blvd, Suite D, Louisville, KY 40207-1293 | 2007-01-05 |
| 1871597781 | Robert Bond Nolan Jr. | Legal Medicine | 4119 Browns Ln, Ste 1, Louisville, KY 40220-1500 | 2005-06-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609064021 | Richard H. Stout, Md Psc | Legal Medicine | 2957 Us Hwy 641 North, Murray, KY 42071-7840 | 2007-10-10 |
| 1891836581 | Stanford Family Medicine & Obstetrics Psc | Legal Medicine | 19 Abes Plaza, Old Hustonville Rd, Liberty, KY 42539 | 2007-02-08 |
| 1679641609 | Kevin Pettus | Legal Medicine | 7786 Lexington Rd, Lancaster, KY 40444-9119 | 2006-11-30 |
| 1326122904 | Rajiv M Naval Srinivas | Legal Medicine | 65 Glendale Drive, Suite 1, Manchester, KY 40962 | 2006-10-24 |
| 1013014133 | Sanjiv Mehta | Legal Medicine | 3615 E John Rowan Blvd Ste 203, Bardstown, KY 40004-3265 | 2006-09-20 |
| 1033154711 | Gary Lee Mcmillan | Legal Medicine | 110 Medical Center Dr, Paducah, KY 42003-7909 | 2006-06-18 |
| 1972568376 | Bullitt County Family Care Center, P.l.l.c. | Legal Medicine | 1578 Highway 44 E, Suite 2, Shepherdsville, KY 40165-7172 | 2006-04-19 |
| 1629051685 | Stuart James Harris | Legal Medicine | 23 Marion St, Cadiz, KY 42211-7949 | 2005-11-23 |
| 1568452290 | Baptist Healthcare System, Inc. | Legal Medicine | 801 Eastern Byp, Richmond, KY 40475 | 2005-10-25 |
| 1134122336 | Narasimha Reddy | Legal Medicine | 106 Columns Plaza Dr, Glasgow, KY 42141-8068 | 2005-05-23 |
| Find all providers with the same taxonomy | ||||
| City | LOUISVILLE |
| Zip Code | 40223 |
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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.