| Dmmd Concierge Llc | |
|
947 Eastern Pkwy Louisville KY 40217-1573 | |
| (502) 361-8801 | |
| (502) 361-8821 |
| Full Name | Dmmd Concierge Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 947 Eastern Pkwy, Louisville, Kentucky |
| Authorized Official Name and Position | Doug Mattingly (OWNER) |
| Authorized Official Contact | 5023618801 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dmmd Concierge Llc 3202 Thousand Oaks Dr Louisville KY 40205-2703 Ph: () - | Dmmd Concierge Llc 947 Eastern Pkwy Louisville KY 40217-1573 Ph: (502) 361-8801 |
| NPI Number | 1114562014 |
|---|---|
| Provider Enumeration Date | 11/14/2019 |
| Last Update Date | 01/30/2020 |
| Medicare PECOS PAC ID | 0244665412 |
|---|---|
| Medicare Enrollment ID | O20200115003266 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114562014 | NPI | - | NPPES |
| 7100646490 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363AM0700X | Physician Assistant - Medical | (* (Not Available)) | Secondary |
| Provider Name | Douglas E Mattingly |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801851886 PECOS PAC ID: 1850378142 Enrollment ID: I20040706000214 |
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