| Pearl Geriatrics And Palliative Medicine, Psc | |
|
2202 Buechel Ave Ste 105 Louisville KY 40218-2672 | |
| (502) 456-0494 | |
| (504) 456-0496 |
| Full Name | Pearl Geriatrics And Palliative Medicine, Psc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2202 Buechel Ave Ste 105, Louisville, Kentucky |
| Authorized Official Name and Position | Osawaru Jude Omoruyi (OWNER) |
| Authorized Official Contact | 5024560494 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pearl Geriatrics And Palliative Medicine, Psc Po Box 37188 Louisville KY 40233-7188 Ph: (502) 456-0494 | Pearl Geriatrics And Palliative Medicine, Psc 2202 Buechel Ave Ste 105 Louisville KY 40218-2672 Ph: (502) 456-0494 |
| NPI Number | 1376865972 |
|---|---|
| Provider Enumeration Date | 02/23/2010 |
| Last Update Date | 01/29/2021 |
| Medicare PECOS PAC ID | 6103954847 |
|---|---|
| Medicare Enrollment ID | O20100517000606 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376865972 | NPI | - | NPPES |
| 7100159350 | Medicaid | KY | |
| 7100134680 | Medicaid | KY |
| Provider Name | Lori Elizabeth Weis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568405942 PECOS PAC ID: 4284526047 Enrollment ID: I20040326000429 |
| Provider Name | Adetokunbo O Omoruyi |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1427275049 PECOS PAC ID: 3072689223 Enrollment ID: I20080911000609 |
| Provider Name | Osawaru Jude Omoruyi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396961967 PECOS PAC ID: 8921190992 Enrollment ID: I20090325000174 |
| Provider Name | Smita Ranjan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831478114 PECOS PAC ID: 8224202023 Enrollment ID: I20111112000044 |
| Provider Name | Oliver E Olson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255696597 PECOS PAC ID: 5991953671 Enrollment ID: I20120921000538 |
| Provider Name | Mark Harris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538542816 PECOS PAC ID: 4789998022 Enrollment ID: I20150730014064 |
| Provider Name | Vicky L. Raisor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194181289 PECOS PAC ID: 9335441096 Enrollment ID: I20160112002322 |
| Provider Name | Virginia A Bonnette |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316041445 PECOS PAC ID: 3870592678 Enrollment ID: I20200114001079 |
| Provider Name | Naomi Jean Eisenback |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417513029 PECOS PAC ID: 4082042957 Enrollment ID: I20200309001219 |
| Provider Name | Chioma C Holland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730788621 PECOS PAC ID: 5092125179 Enrollment ID: I20201030000461 |
| Provider Name | Joni Marie Miles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265102941 PECOS PAC ID: 7719375757 Enrollment ID: I20211025002999 |
| Provider Name | Nina Jankoski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982342879 PECOS PAC ID: 2668858614 Enrollment ID: I20220929000373 |
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