Provider Demographics
NPI:1023170693
Name:UNIVERSITY MEDICAL CENTER INC
Entity type:Organization
Organization Name:UNIVERSITY MEDICAL CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-562-4002
Mailing Address - Street 1:530 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1675
Mailing Address - Country:US
Mailing Address - Phone:502-562-4002
Mailing Address - Fax:562-562-3333
Practice Address - Street 1:530 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1675
Practice Address - Country:US
Practice Address - Phone:502-562-4002
Practice Address - Fax:562-562-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200289291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5000046OtherUNITED HEALTH CARE
KY1048739OtherPASSPORT HEALTH PLAN
KY61101OtherHUMANA
KY7100054770Medicaid
IN200912680AMedicaid
KY2432182000OtherPASSPORT ADVANTAGE
KY62308OtherCIGNA
KY000000054937OtherBLUE CROSS
KY4017301OtherMEDICARE ID-TYPE UNSPECIFIED
KY60054OtherAETNA