SKIN GROUP PLLC (NPI# 1366564494) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366564494 |
| Entity Type | Organization |
| Organization Name | SKIN GROUP PLLC |
| Practice Address |
2307 River Rd Ste 101 Louisville KY 40206-5000 |
| Mailing Address |
Po Box 36422 Louisville KY 40233-6422 |
| Practice Telephone | 5025836647 |
| Practice Fax Number | 5025854824 |
| Mailing Telephone | 5025836647 |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2020-02-18 |
| Authorized Official Name | DR. ROBERT H ZAX (PRESIDENT) |
| Authorized Official Telephone | 5025836647 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | PA1034 | KY | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363L00000X | Nurse Practitioner | 4440P | KY | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
25359 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 65938797 | 05 | |
| KY | RR MCR | DA0326 | 01 |
| KY | 78904968 | 05 | |
| KY | CLIA NUMBER | 18D0934789 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013925106 | Skin Group Pllc | Dermatology | 2211 Greene Way, Ste 100, Louisville, KY 40220-4076 | 2006-08-04 |
| Street Address |
2307 RIVER RD STE 101 |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40206-5000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689659781 | Robert Henry Zax | Dermatology | 2307 River Rd Ste 101, Louisville, KY 40206-5000 | 2005-12-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285243477 | Stephanie Atherton | Nurse Practitioner | 1623 Story Ave, Louisville, KY 40206 | 2020-07-24 |
| 1023547460 | Jeffrey Obiora | Student in an Organized Health Care Education/Training Program | 500 South Preston St, Room 305, Lousiville, KY 40206 | 2017-06-08 |
| 1053840710 | Mary Oliver Humke | Lactation Consultant, Non-RN | 155 N Galt Ave, Louisville, KY 40206 | 2017-06-07 |
| 1417304908 | James Edward Meffert Sr. | Dentist | 1618 Story Ave. (home/office Setting), Louisville, KY 40206 | 2016-05-16 |
| 1235516527 | Jara Nashelle Vega Velez | Internal Medicine | 800 Zorn Ave Dept Of, Louisville, KY 40206 | 2015-05-06 |
| 1184058885 | Reba D Ziller | Occupational Therapist | 4604 Lowe Road, Regis Woods Rehab Center, Louisville, KY 40206 | 2013-08-29 |
| 1407109176 | Jessica L Hoback | Physical Therapy Assistant | 2141 Sycamore Avenue, Louisville, KY 40206 | 2012-10-18 |
| 1598039315 | Mary Barbara Sowers | Emergency Medicine | 611 Emery Rd, Louisville, KY 40206 | 2012-02-24 |
| 1053628479 | Adrian J Pellegrini Md | Nurse Practitioner | 170 Crescent Ave, Louisville, KY 40206 | 2010-09-07 |
| 1518297761 | Kiley Nontell Mcneill | Behavioral Analyst | 1100 East Market St., Louisville, KY 40206 | 2010-01-12 |
| Find all providers in zip 40206 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861897217 | Forefront Dermatology, S.c. | Dermatology | 501 S 2nd St, Louisville, KY 40202 | 2014-10-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821435074 | Robert Louis Skaggs II | Dermatology | 1818 Wallace Court, Suite 301, Bowling Green, KY 42103 | 2013-05-29 |
| 1326203142 | Dermatology of Southern Kentucky Pllc | Dermatology | 85 Tower Cir, Somerset, KY 42503-3476 | 2008-07-21 |
| 1740315589 | Jack Foster Ditty Jr. | Dermatology | 100 Saint Christopher Dr, Ashland, KY 41101-7016 | 2007-02-22 |
| 1871593996 | Samuel J Pruden II | Dermatology | 989 Governors Ln Ste 220, Lexington, KY 40513-1175 | 2005-07-29 |
| 1457355174 | John L Buker | Dermatology | 3475 Richmond Rd, Ste 200, Lexington, KY 40509-2500 | 2005-06-10 |
| 1902302987 | Kentucky Skin Cancer Center Pllc | Dermatology | 1818 Wallace Court, Suite 301, Bowling Green, KY 42103 | 2018-03-30 |
| 1477922672 | Forefront Dermatology, S.c. | Dermatology | 2333 Ring Rd, Elizabethtown, KY 42701 | 2015-09-17 |
| 1003133901 | Joseph Allen Blackmon | Dermatology | 2424 Harrodsburg Rd Ste 200, Lexington, KY 40503 | 2010-05-01 |
| 1609924018 | Buker Office Based Surgery, Pllc | Dermatology | 3475 Richmond Rd, Suite 200, Lexington, KY 40509-2500 | 2007-01-08 |
| 1932132768 | Dermatology and Skin Cancer Specialists, Psc | Dermatology | 2200 E Parrish Ave, Bldg E Suite 205, Owensboro, KY 42303-1449 | 2006-07-07 |
| Find all providers with the same taxonomy | ||||
| City | LOUISVILLE |
| Zip Code | 40206 |
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| 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.