| Shawnee Christian Healthcare Center Inc | |
|
234 Amy Ave Louisville KY 40212-2522 | |
| (502) 778-0001 | |
| Not Available |
| Full Name | Shawnee Christian Healthcare Center Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 234 Amy Ave, Louisville, Kentucky |
| Authorized Official Name and Position | Kirstie Matzek (PRESIDENT) |
| Authorized Official Contact | 5027780001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shawnee Christian Healthcare Center Inc 234 Amy Ave Louisville KY 40212-2522 Ph: (502) 778-0001 | Shawnee Christian Healthcare Center Inc 234 Amy Ave Louisville KY 40212-2522 Ph: (502) 778-0001 |
| NPI Number | 1225333743 |
|---|---|
| Provider Enumeration Date | 01/13/2011 |
| Last Update Date | 08/07/2024 |
| Certification Date | 08/07/2024 |
| Medicare PECOS PAC ID | 8921280926 |
|---|---|
| Medicare Enrollment ID | O20110312000044 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225333743 | NPI | - | NPPES |
| 7100150090 | Medicaid | KY |
| Provider Name | Christopher L Sperry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386870046 PECOS PAC ID: 0345435384 Enrollment ID: I20120725000749 |
| Provider Name | Cynethia Lm Bethel-hines |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669785465 PECOS PAC ID: 2668612516 Enrollment ID: I20130717000420 |
| Provider Name | Nicole M Delisi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558671701 PECOS PAC ID: 7810118825 Enrollment ID: I20141016000386 |
| Provider Name | Greta Bakanowski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245744960 PECOS PAC ID: 8729341177 Enrollment ID: I20180504000119 |
| Provider Name | Amy Nolan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104160399 PECOS PAC ID: 2264777598 Enrollment ID: I20181214001236 |
| Provider Name | Sherry B Babbage Melisizwe |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1831241173 PECOS PAC ID: 7517275076 Enrollment ID: I20190128001854 |
| Provider Name | Aiesha Cole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063979458 PECOS PAC ID: 1456761535 Enrollment ID: I20201030000452 |
| Provider Name | Hannah S Stearns |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063016533 PECOS PAC ID: 6103227137 Enrollment ID: I20210629001358 |
| Provider Name | Christina F Rademaker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811629132 PECOS PAC ID: 1052794377 Enrollment ID: I20220819001058 |
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