| Russell Neighborood Health Center | |
|
1425 W. Broadway Louisville KY 40202 | |
| (502) 584-2992 | |
| (502) 584-3715 |
| Full Name | Russell Neighborood Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1425 W. Broadway, 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 |
|---|---|
| Russell Neighborood Health Center 3015 Wilson Ave Louisville KY 40211-1969 Ph: (502) 774-4401 | Russell Neighborood Health Center 1425 W. Broadway Louisville KY 40202 Ph: (502) 584-2992 |
| NPI Number | 1255354361 |
|---|---|
| Provider Enumeration Date | 07/26/2006 |
| Last Update Date | 11/02/2021 |
| Medicare PECOS PAC ID | 1658268974 |
|---|---|
| Medicare Enrollment ID | O20040302000539 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255354361 | NPI | - | NPPES |
| 31000011 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 700005 (Kentucky) | Primary |
| Provider Name | Jessica Dowe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265497499 PECOS PAC ID: 6103711973 Enrollment ID: I20040219000699 |
| Provider Name | Sharon S Jamison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104815141 PECOS PAC ID: 7012807282 Enrollment ID: I20040319000537 |
| Provider Name | Giavonne D Rondo Hillman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124083514 PECOS PAC ID: 8729050976 Enrollment ID: I20050427000874 |
| Provider Name | Romeo S Ambrosio |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1194847871 PECOS PAC ID: 0143314633 Enrollment ID: I20070914000034 |
| Provider Name | Lisa G Glass |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275534091 PECOS PAC ID: 2264511229 Enrollment ID: I20080502000330 |
| Provider Name | Jose T Lorenzo |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1154434884 PECOS PAC ID: 0143388637 Enrollment ID: I20081028000484 |
| Provider Name | Fe N Briones |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598838294 PECOS PAC ID: 4082779277 Enrollment ID: I20090224000009 |
| Provider Name | Dejuana N Frazier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285964551 PECOS PAC ID: 1254510043 Enrollment ID: I20110126000194 |
| Provider Name | Cicely M Hamilton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710237532 PECOS PAC ID: 2062662919 Enrollment ID: I20121030000475 |
| Provider Name | Laretta V Dodson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932531357 PECOS PAC ID: 0446493043 Enrollment ID: I20130829000735 |
| Provider Name | Lecresha Y Sewell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093107781 PECOS PAC ID: 6002133006 Enrollment ID: I20150401001835 |
| Provider Name | Amber Jainia Wood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538616578 PECOS PAC ID: 7416244884 Enrollment ID: I20160928002387 |
| Provider Name | Melissa Hines |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801343140 PECOS PAC ID: 3375830565 Enrollment ID: I20161003002450 |
| Provider Name | Kelly A Jedlicki |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528155314 PECOS PAC ID: 5597042598 Enrollment ID: I20170428002097 |
| Provider Name | Miasha Renee Crutchfield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003344854 PECOS PAC ID: 0244501906 Enrollment ID: I20180209002156 |
| Provider Name | Erin Lynn Dedman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639729445 PECOS PAC ID: 1153653605 Enrollment ID: I20191101001338 |
| Provider Name | Mark A Bush |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730733783 PECOS PAC ID: 7113352675 Enrollment ID: I20200110002580 |
| Provider Name | Janneve Sankawulo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356954366 PECOS PAC ID: 3173941556 Enrollment ID: I20200916003110 |
| Provider Name | Symone Stephens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124638184 PECOS PAC ID: 7113347527 Enrollment ID: I20201022003570 |
| Provider Name | Tara Lynn Denton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063913986 PECOS PAC ID: 2264852656 Enrollment ID: I20201023003065 |
| Provider Name | Domini A Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982211405 PECOS PAC ID: 6608286695 Enrollment ID: I20201103000610 |
| Provider Name | Yazmine Jaquez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083215362 PECOS PAC ID: 5092126342 Enrollment ID: I20201118001184 |
| Provider Name | Adam Mitchell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881298727 PECOS PAC ID: 6507279148 Enrollment ID: I20201229000372 |
| Provider Name | Meaghen Lee Rodriguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437739166 PECOS PAC ID: 3678982444 Enrollment ID: I20210506002487 |
| Provider Name | Phoebe Morkos Girgis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538731484 PECOS PAC ID: 7012304082 Enrollment ID: I20220420003092 |
| Provider Name | Alice Boos-edwards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144853029 PECOS PAC ID: 8123406576 Enrollment ID: I20220526000455 |
| Provider Name | Margo Renee Pfetzer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760103915 PECOS PAC ID: 3870979339 Enrollment ID: I20221006001469 |
| Provider Name | Leandro Ernesto Hernandez Diaz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376279711 PECOS PAC ID: 9335515634 Enrollment ID: I20221011001883 |
| Provider Name | Dyna Fay Zehnder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992366199 PECOS PAC ID: 8426424789 Enrollment ID: I20221012001696 |
| Provider Name | Ryan Hopson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316655079 PECOS PAC ID: 9436527454 Enrollment ID: I20221123001545 |
| Provider Name | Jennifer Estes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841909272 PECOS PAC ID: 1254700438 Enrollment ID: I20221209001642 |
| Provider Name | Breanna Bader |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972210805 PECOS PAC ID: 8022488956 Enrollment ID: I20230110001521 |
| Provider Name | Elizabeth Zarantonello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730674045 PECOS PAC ID: 5597016790 Enrollment ID: I20230201003208 |
| Provider Name | Katelyn Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629755749 PECOS PAC ID: 0648630699 Enrollment ID: I20230721001956 |
| Provider Name | Vicki Larue |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932158516 PECOS PAC ID: 2163526567 Enrollment ID: I20230907002547 |
| Provider Name | Alyson Estes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992563951 PECOS PAC ID: 8820436512 Enrollment ID: I20240401000836 |
| Provider Name | Erin Dunagan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154187037 PECOS PAC ID: 1355780917 Enrollment ID: I20240415003581 |
| Provider Name | Kiara Farris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083470975 PECOS PAC ID: 6305287590 Enrollment ID: I20240520001061 |
Medicine Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 15103 Chestnut Ridge Cir, Louisville, KY 40245 Phone: 502-742-9149 Fax: 502-896-7292 | |
Veloz Medical Services Corp Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6911 Shepherdsville Rd, Louisville, KY 40219 Phone: 502-644-3076 | |
Kentucky Joint Specialists Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4010 Dupont Cir Ste 310, Louisville, KY 40207 Phone: 502-771-5432 Fax: 502-771-5430 | |
Mobile Md Holdings Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 9510 Ormsby Station Road, Suite 100b, Louisville, KY 40223 Phone: 502-253-4140 | |
Edina Torlak Md, Psc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3950 Kresge Way Ste 302, Louisville, KY 40207 Phone: 502-893-7372 | |
Shirley J Meredith, Md, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4000 Kresge Way, Baptist East Wound Care Center, Louisville, KY 40207 Phone: 502-259-4470 Fax: 502-259-4471 | |
Infectious Disease Specialists Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 205 Locust Creek Blvd, Louisville, KY 40245 Phone: 502-916-3130 Fax: 502-916-3230 |