SOUTH OLDHAM FAMILY CARE (NPI# 1043597073) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043597073 |
| Entity Type | Organization |
| Organization Name | SOUTH OLDHAM FAMILY CARE |
| Practice Address |
6520 W Highway 22 Crestwood KY 40014-9305 |
| Practice Telephone | 5022418488 |
| Practice Fax Number | 5022417424 |
| Mailing Telephone | 5022418488 |
| Mailing Fax Number | 5022417424 |
| Enumeration Date | 2011-11-04 |
| Last Update Date | 2011-11-04 |
| Authorized Official Name | KAMLESH DAVE (OWNER) |
| Authorized Official Telephone | 5022418488 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | 34317 | KY | Allopathic & Osteopathic Physicians |
| Y | 207Q00000X | Family Medicine | 34317 | KY | Allopathic & Osteopathic Physicians |
| Street Address |
6520 W HIGHWAY 22 |
| City | CRESTWOOD |
| State | KY |
| Zip Code | 40014-9305 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679058804 | Grace Primary Care Pllc | Nurse Practitioner | 6520 W Highway 22, Crestwood, KY 40014 | 2018-10-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720411556 | Meagan L Vowels | Behavioral Analyst | 5895 W. Hwy 146, Crestwood, KY 40014 | 2013-08-15 |
| 1003157538 | Craig L Satterley | Physical Therapist | 6003 Pleasant Colony Ct Ste 3, Crestwood, KY 40014 | 2013-03-07 |
| 1871868802 | Wallace Lyle Past Sr. | General Practice | 4608 Heritage Manor, Crestwood, KY 40014 | 2012-03-08 |
| 1609153725 | Patricia Ann Gray | Behavioral Analyst | 5895 W Highway 146, Crestwood, KY 40014 | 2011-11-03 |
| 1528374253 | Laura R Carroll | Dentist | 6344 W. Hwy 146 Ste 100, Crestwood, KY 40014 | 2010-08-18 |
| 1699922849 | Mortenson Family Dental Center | Clinic/Center | 6408 W Hwy 146, Crestwood, KY 40014 | 2008-08-19 |
| 1760658546 | Kathy J. Pansegrau, Dc, Psc | Chiropractor | 6402 Westwind Way, Suite 5, Crestwood, KY 40014 | 2008-05-01 |
| 1952584054 | Alyssa Ann Dykgraaf | Dentist | 5805 Whwy 22, Ste 100, Crestwood, KY 40014 | 2007-12-11 |
| 1780881649 | Gwinn A. K. Vonnahme | Dentist | 5998 Pleasant Colony Ct. Suite 23, Crestwood, KY 40014 | 2007-07-02 |
| 1326250960 | Sue B Feeley | Dentist | 6225 W Hwy 146, Crestwood, KY 40014 | 2007-05-04 |
| Find all providers in zip 40014 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457693954 | Jianxia Wang | Family Medicine | 6411 Veterans Memorial Pkwy, Crestwood, KY 40014-8698 | 2013-03-22 |
| 1306103205 | Milum Wound Care Psc | Family Medicine | 3114 Setting Sun Ct, Crestwood, KY 40014-8409 | 2012-04-16 |
| 1215074026 | Midwest Physician Group Ltd | Family Medicine | 13811 Cicero Ave, Crestwood, IL 60445-1826 | 2007-01-31 |
| 1497847255 | Ebony Nicole Johnson | Family Medicine | 4742 Cal Sag Rd, Crestwood, IL 60418 | 2006-09-29 |
| 1427063379 | Crestwood Family Medicine | Family Medicine | 6106 Crestwood Sta Ste A, Crestwood, KY 40014-9473 | 2006-07-29 |
| 1174541510 | Donna Gatewood | Family Medicine | 6580 Kenwood Crossing Road, Crestwood, KY 40014 | 2006-07-17 |
| 1639102585 | Richard A Hefner | Family Medicine | 6580 Kenwood Crossings Road, Crestwood, KY 40014 | 2006-07-07 |
| 1992746309 | Crestwood Medical Associates Ltd | Family Medicine | 13117 Rivercrest Dr, Crestwood, IL 60418-4419 | 2006-06-08 |
| 1629034574 | Renee V Girdler | Family Medicine | 6411 Veterans Memorial Parkway, Crestwood, KY 40014 | 2006-04-20 |
| 1619968013 | Michael Ames Punnett | Family Medicine | 6580 Kenwood Crossing Rd, Crestwood, KY 40014-7614 | 2005-11-03 |
| Find all providers in CRESTWOOD | ||||
Please comment or provide details below to improve the information on SOUTH OLDHAM FAMILY CARE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.