| Marina Sud | |
|
1834 Gresham Rd Louisville KY 40205-2424 | |
| (914) 475-7256 | |
| Not Available |
| Full Name | Marina Sud |
|---|---|
| Speciality | Psychologist |
| Location | 1834 Gresham Rd, Louisville, Kentucky |
| Authorized Official Name and Position | Marina Sud (OWNER) |
| Authorized Official Contact | 9144757256 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Marina Sud 1834 Gresham Rd Louisville KY 40205-2424 Ph: (914) 475-7256 | Marina Sud 1834 Gresham Rd Louisville KY 40205-2424 Ph: (914) 475-7256 |
| NPI Number | 1104446921 |
|---|---|
| Provider Enumeration Date | 04/22/2020 |
| Last Update Date | 04/22/2020 |
| Certification Date | 04/22/2020 |
| Medicare PECOS PAC ID | 9133541931 |
|---|---|
| Medicare Enrollment ID | O20200624002223 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104446921 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Marina Sud |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1538230651 PECOS PAC ID: 2668464173 Enrollment ID: I20140325001191 |
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