| Park Duvalle At Newburg | |
|
3828 Bardstown Rd Louisville KY 40218-1527 | |
| (502) 479-8930 | |
| Not Available |
| Full Name | Park Duvalle At Newburg |
|---|---|
| Speciality | Clinic/Center |
| Location | 3828 Bardstown Rd, Louisville, Kentucky |
| Authorized Official Name and Position | Swannie Jett (CEO) |
| Authorized Official Contact | 5027744401 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Park Duvalle At Newburg 3015 Wilson Ave Louisville KY 40211-1969 Ph: (502) 774-4401 | Park Duvalle At Newburg 3828 Bardstown Rd Louisville KY 40218-1527 Ph: (502) 479-8930 |
| NPI Number | 1780698506 |
|---|---|
| Provider Enumeration Date | 07/28/2006 |
| Last Update Date | 11/11/2022 |
| Medicare PECOS PAC ID | 1658268974 |
|---|---|
| Medicare Enrollment ID | O20100719000033 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780698506 | NPI | - | NPPES |
| 31000011 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 700005 (Kentucky) | Primary |
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