| Kentucky Medical Specialists, Psc | |
|
4001 Kresge Way Ste # 236 Louisville KY 40207 | |
| (502) 893-7372 | |
| (502) 409-4715 |
| Full Name | Kentucky Medical Specialists, Psc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4001 Kresge Way Ste # 236, Louisville, Kentucky |
| Authorized Official Name and Position | Marlon R Chagua (PRESIDENT) |
| Authorized Official Contact | 5028937372 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kentucky Medical Specialists, Psc 4001 Kresge Way Ste # 236 Louisville KY 40207 Ph: (502) 893-7372 | Kentucky Medical Specialists, Psc 4001 Kresge Way Ste # 236 Louisville KY 40207 Ph: (502) 893-7372 |
| NPI Number | 1295090884 |
|---|---|
| Provider Enumeration Date | 07/10/2012 |
| Last Update Date | 05/01/2019 |
| Medicare PECOS PAC ID | 3678719648 |
|---|---|
| Medicare Enrollment ID | O20130417000378 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295090884 | NPI | - | NPPES |
| 64063266 | Medicaid | KY | |
| 7100235310 | Medicaid | KY |
| Provider Name | Marlon R Chagua |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407811870 PECOS PAC ID: 7214906536 Enrollment ID: I20041001000923 |
| Provider Name | Debra J Strotman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679608152 PECOS PAC ID: 7618900127 Enrollment ID: I20050915000275 |
| Provider Name | Sandra M. Buchanan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649665746 PECOS PAC ID: 3375864481 Enrollment ID: I20150601002789 |
| Provider Name | James R Packer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730835968 PECOS PAC ID: 7113303371 Enrollment ID: I20230109000242 |
| Provider Name | Hannah Olivia Jazdzewski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194441113 PECOS PAC ID: 4981078623 Enrollment ID: I20230321001749 |
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