Graceway Direct Primary Care, Pllc | |
5807 Hasbrook Dr Louisville KY 40229-2984 | |
(502) 709-0590 | |
Not Available |
Full Name | Graceway Direct Primary Care, Pllc |
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Speciality | Clinic/Center |
Location | 5807 Hasbrook Dr, Louisville, Kentucky |
Authorized Official Name and Position | Lori Williams (OWNER) |
Authorized Official Contact | 5027090590 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Graceway Direct Primary Care, Pllc 5807 Hasbrook Dr Louisville KY 40229-2984 Ph: () - | Graceway Direct Primary Care, Pllc 5807 Hasbrook Dr Louisville KY 40229-2984 Ph: (502) 709-0590 |
NPI Number | 1689255127 |
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Provider Enumeration Date | 04/16/2021 |
Last Update Date | 04/16/2021 |
Medicare PECOS PAC ID | 6901292267 |
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Medicare Enrollment ID | O20220413002034 |
Identifier | Type | State | Issuer |
---|---|---|---|
1689255127 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Lori Williams |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1043830102 PECOS PAC ID: 8527478304 Enrollment ID: I20201105002505 |
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