| Park Duvalle Community Health Center, Inc. | |
|
3015 Wilson Ave Louisville KY 40211-1969 | |
| (502) 774-4401 | |
| (502) 772-4783 |
| Full Name | Park Duvalle Community Health Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 3015 Wilson Ave, 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 Community Health Center, Inc. 3015 Wilson Ave Louisville KY 40211-1969 Ph: (502) 774-4401 | Park Duvalle Community Health Center, Inc. 3015 Wilson Ave Louisville KY 40211-1969 Ph: (502) 774-4401 |
| NPI Number | 1245253160 |
|---|---|
| Provider Enumeration Date | 07/25/2006 |
| Last Update Date | 11/02/2021 |
| Medicare PECOS PAC ID | 1658268974 |
|---|---|
| Medicare Enrollment ID | O20040323000421 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245253160 | 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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