| Vintage Care Inc. | |
|
2000 Newburg Rd Louisville KY 40205-1803 | |
| (502) 883-6744 | |
| (502) 883-6743 |
| Full Name | Vintage Care Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 2000 Newburg Rd, Louisville, Kentucky |
| Authorized Official Name and Position | Bonnie A Lazor (OWNER/PHYSICIAN) |
| Authorized Official Contact | 5028836744 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vintage Care Inc. Po Box 436196 Louisville KY 40253-6196 Ph: (502) 883-6744 | Vintage Care Inc. 2000 Newburg Rd Louisville KY 40205-1803 Ph: (502) 883-6744 |
| NPI Number | 1376598763 |
|---|---|
| Provider Enumeration Date | 05/23/2006 |
| Last Update Date | 10/19/2016 |
| Medicare PECOS PAC ID | 7810900115 |
|---|---|
| Medicare Enrollment ID | O20060802000387 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376598763 | NPI | - | NPPES |
| 50011327 | Other | PASSPORT | |
| DF1586 | Other | RAILROAD MEDICARE | |
| 2742752000 | Other | PASSPORT ADVANTAGE | |
| 65945339 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
| Provider Name | Joan Shemwell |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609921758 PECOS PAC ID: 5496649212 Enrollment ID: I20040212000048 |
| Provider Name | Bonnie A. Lazor |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1548214059 PECOS PAC ID: 3678535226 Enrollment ID: I20041027000487 |
| Provider Name | Sandra M. Buchanan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649665746 PECOS PAC ID: 3375864481 Enrollment ID: I20150601002789 |
| Provider Name | Angela B Hackman |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1235366287 PECOS PAC ID: 6305085887 Enrollment ID: I20150827000253 |
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