| Hurstbourne Family Care | |
|
2304 Hurstbourne Village Dr Ste 500 Louisville KY 40299-1886 | |
| (502) 583-3189 | |
| (502) 581-1463 |
| Full Name | Hurstbourne Family Care |
|---|---|
| Speciality | Family Medicine |
| Location | 2304 Hurstbourne Village Dr Ste 500, Louisville, Kentucky |
| Authorized Official Name and Position | George Stege (OWNER) |
| Authorized Official Contact | 5026537643 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hurstbourne Family Care 2304 Hurstbourne Village Dr Ste 500 Louisville KY 40299-1886 Ph: (502) 583-3189 | Hurstbourne Family Care 2304 Hurstbourne Village Dr Ste 500 Louisville KY 40299-1886 Ph: (502) 583-3189 |
| NPI Number | 1083211841 |
|---|---|
| Provider Enumeration Date | 10/05/2020 |
| Last Update Date | 01/15/2021 |
| Medicare PECOS PAC ID | 7810301520 |
|---|---|
| Medicare Enrollment ID | O20210120001966 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083211841 | NPI | - | NPPES |
| 20839 | Other | KY | MEDICAL LICENSE |
| K144380 | Other | KY | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
| Provider Name | George C Stege |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548284425 PECOS PAC ID: 7719954460 Enrollment ID: I20090202000169 |
| Provider Name | Theresa Ann Goodman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316379324 PECOS PAC ID: 2264656149 Enrollment ID: I20140616001449 |
| Provider Name | Phyllis Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497130017 PECOS PAC ID: 3274841051 Enrollment ID: I20150928001528 |
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