| Vitae Health Medical Kentucky, Llc | |
|
3500 Good Samaritan Way Louisville KY 40299-6117 | |
| (224) 777-8034 | |
| Not Available |
| Full Name | Vitae Health Medical Kentucky, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3500 Good Samaritan Way, Louisville, Kentucky |
| Authorized Official Name and Position | Amish M Patel (PRESIDENT) |
| Authorized Official Contact | 2247778034 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitae Health Medical Kentucky, Llc 415 W Golf Rd Ste 26 Arlington Heights IL 60005-3923 Ph: (224) 777-8034 | Vitae Health Medical Kentucky, Llc 3500 Good Samaritan Way Louisville KY 40299-6117 Ph: (224) 777-8034 |
| NPI Number | 1629600879 |
|---|---|
| Provider Enumeration Date | 02/06/2020 |
| Last Update Date | 09/30/2021 |
| Certification Date | 09/30/2021 |
| Medicare PECOS PAC ID | 3173952637 |
|---|---|
| Medicare Enrollment ID | O20200403001181 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629600879 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Manoj H Majmudar |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1659336097 PECOS PAC ID: 7113981168 Enrollment ID: I20041118000661 |
| Provider Name | Osawaru Jude Omoruyi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396961967 PECOS PAC ID: 8921190992 Enrollment ID: I20090325000174 |
| Provider Name | Lela Cole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609104546 PECOS PAC ID: 1850433848 Enrollment ID: I20100129000183 |
| Provider Name | Mary Angela Rogers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891840542 PECOS PAC ID: 9234102427 Enrollment ID: I20101022000164 |
| Provider Name | Sandra Lucinda Hazelwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285915256 PECOS PAC ID: 9931373495 Enrollment ID: I20111117000753 |
| Provider Name | Brandi L Stacy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760722144 PECOS PAC ID: 8022253921 Enrollment ID: I20130325000529 |
| Provider Name | Deena D Carrico |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033577564 PECOS PAC ID: 9133428543 Enrollment ID: I20160505001108 |
| Provider Name | David Fielder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811051014 PECOS PAC ID: 1153304092 Enrollment ID: I20160805002431 |
| Provider Name | Jenny Thomas Holt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669927760 PECOS PAC ID: 0749568897 Enrollment ID: I20161025002073 |
| Provider Name | Delasaria Lihon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740504174 PECOS PAC ID: 6103184106 Enrollment ID: I20171221000198 |
| Provider Name | Michael Don Gordon |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1225562622 PECOS PAC ID: 6406116300 Enrollment ID: I20180605000558 |
| Provider Name | Brittany Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679106991 PECOS PAC ID: 6103254693 Enrollment ID: I20200316002070 |
| Provider Name | Victoria Lee Bivins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225663677 PECOS PAC ID: 9537599527 Enrollment ID: I20200414003387 |
| Provider Name | Jennifer Mcdowell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225378904 PECOS PAC ID: 0547406480 Enrollment ID: I20200618001783 |
| Provider Name | Marsheila J Tincher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679613517 PECOS PAC ID: 2567879174 Enrollment ID: I20210326002021 |
| Provider Name | Laura A Fieser |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083188668 PECOS PAC ID: 8527488642 Enrollment ID: I20210722002909 |
| Provider Name | Roy D Sellers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396410502 PECOS PAC ID: 3173912649 Enrollment ID: I20211123002473 |
| Provider Name | Bailey R Fuller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467119057 PECOS PAC ID: 2062899438 Enrollment ID: I20220525000193 |
| Provider Name | Megan Speed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235721150 PECOS PAC ID: 4385026038 Enrollment ID: I20220728000547 |
| Provider Name | Mikayla Anne Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568144053 PECOS PAC ID: 8123482809 Enrollment ID: I20230913003683 |
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