PARK DUVALLE COMMUNITY HEALTH CENTER, INC (NPI# 1518184613) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518184613 |
| Entity Type | Organization |
| Organization Name | PARK DUVALLE COMMUNITY HEALTH CENTER, INC |
| Practice Address |
3015 Wilson Ave Louisville KY 40211-1969 |
| Practice Telephone | 5027744401 |
| Practice Fax Number | 5027724783 |
| Mailing Telephone | 5027744401 |
| Mailing Fax Number | 5027724783 |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2014-02-24 |
| Authorized Official Name | ANTHONY OMOJASOLA (CEO) |
| Authorized Official Telephone | 5027744401 |
| Authorized Official Credential | CEO, DR. PH, FAC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0002X |
Pharmacy Specialization: Clinic Pharmacy |
Suppliers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780698506 | Park Duvalle Community Health Center, Inc | Clinic/Center | 2237 Hikes Ln, Louisville, KY 40218-2203 | 2006-07-28 |
| 1275151292 | Park Duvalle Community Health Center, Inc | Clinic/Center | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-07-07 |
| 1639727951 | Park Duvalle Community Health Center, Inc | Clinic/Center | 1130 W Chestnut St, Louisville, KY 40203-2047 | 2019-08-29 |
| 1811545403 | Park Duvalle Community Health Center, Inc | Clinic/Center | 5901 Greenwood Rd, Louisville, KY 40258-2409 | 2019-08-28 |
| 1851957252 | Park Duvalle Community Health Center, Inc | Clinic/Center | 75 Park Rd, Wing #1, New Castle, KY 40050-3095 | 2019-05-13 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PARK DUVALLE COMMUNITY HEALTH CENTER, INC. | 3015 Wilson Ave, Louisville, KY 40211-1969 |
| Street Address |
3015 WILSON AVE |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40211-1969 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275534091 | Lisa G Glass | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2005-08-02 |
| 1083215362 | Yazmine Jaquez | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-11-04 |
| 1982211405 | Domini Williams | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-09-29 |
| 1497361091 | Treana Redd | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-09-18 |
| 1356954366 | Janneve Sankawulo | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-08-28 |
| 1588274260 | Robyn May | Dentist | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-08-06 |
| 1124638184 | Symone Stephens | Registered Nurse | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-08-05 |
| 1275151292 | Park Duvalle Community Health Center, Inc | Clinic/Center | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-07-07 |
| 1598312415 | Elissa Grider | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2019-08-26 |
| 1730733783 | Mark A Bush | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211 | 2019-07-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942792940 | Kare LLC | Dentist | 2500 W Broadway Ste 500, Louisville, KY 40211 | 2018-06-05 |
| 1265943716 | Practicare Home Care Services, LLC | Nurse Practitioner | 1667 Russell Lee Dr, Louisville, KY 40211 | 2017-10-23 |
| 1518478221 | Latoya Samantha Hall | Counselor | 646 South 36th Street, Louisville, KY 40211 | 2017-10-20 |
| 1003071200 | Mark Cassol Md Psc | Ophthalmology | 2600 W. Broadway, Suite 105, Louisville, KY 40211 | 2008-07-28 |
| 1194919548 | Hardin Housing Corp | Assisted Living Facility | 2035 S 41st St, Louisville, KY 40211 | 2007-08-29 |
| 1184770562 | Eta Day Care Center LLC | Case Management | 724 So 44th Street, Louisville, KY 40211 | 2007-01-26 |
| 1871571356 | Alice C Gunnison | Physician Assistant | 2406 West Broadway, Jencare Neighborhood Medical Center West Broadway, LLC, Louisville, KY 40211 | 2006-01-05 |
| 1730694266 | Orchid House, Inc. | Early Intervention Provider Agency | 703 S 31st St, Louisville, KY 40211 | 2017-12-06 |
| 1891188785 | Mary Jo Pitts | Registered Nurse | 2406 West Broadway, Jencare Neighborhood Medical Center West Broadway, LLC, Louisville, KY 40211 | 2015-03-17 |
| 1164717492 | Priscilla Nana Ama Owusu | Internal Medicine | 2406 W Broadway, Louisville, KY 40211 | 2011-06-15 |
| Find all providers in zip 40211 | ||||
| Taxonomy Code | 3336C0002X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Clinic Pharmacy |
| A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245688035 | Family Health Centers Inc | Pharmacy | 712 E Muhammad Ali Blvd, Louisville, KY 40202-1643 | 2016-06-02 |
| 1144467770 | Central State Hospital | Pharmacy | 10510 La Grange Rd, Louisville, KY 40223-1277 | 2009-01-20 |
| 1740449636 | University Medical Center Inc | Pharmacy | 401 E Chestnut St, Suite 180, Louisville, KY 40202-5700 | 2008-06-05 |
| 1982789459 | Family Health Center Pharmacy | Pharmacy | 2215 Portland Ave, Louisville, KY 40212-1033 | 2006-10-25 |
| 1477506202 | Family Health Center Pharmacy | Pharmacy | 2215 Portland Ave, Louisville, KY 40212-1033 | 2006-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679131775 | Vaxclinic, LLC | Pharmacy | 1301 Winchester Rd Ste 13, Lexington, KY 40505-4132 | 2019-06-03 |
| 1780138396 | Oncology Associates Inc Psc | Pharmacy | 2603 Kentucky Ave Ste 403, Paducah, KY 42003-3830 | 2016-08-11 |
| 1386057990 | University of Kentucky | Pharmacy | 310 South Limestone St, Room C-017, Lexington, KY 40508-3008 | 2014-06-11 |
| 1194066894 | Sterling Health Solutions, Inc | Pharmacy | 209 North Maysville St, Suite 200, Mt. Sterling, KY 40353 | 2013-03-06 |
| 1316074990 | Lexington-fayette Urban-county Health Department | Pharmacy | 1640 Bryan Station Rd, Lexington, KY 40505-2144 | 2007-02-28 |
| 1265584023 | M.t.o. Pharmacy, Inc | Pharmacy | 121 W Virginia Ave Ste E100, Pineville, KY 40977-1600 | 2007-01-18 |
| 1679660823 | Central City Clinic Pharmacy Inc | Pharmacy | 203 N 2nd St, Central City, KY 42330-1205 | 2006-10-09 |
| 1679660393 | St. Claire Medical Center Dba Bath County Medical Clinic | Pharmacy | 632 Slate Avenue, Owingsville, KY 40360 | 2006-10-06 |
| 1619922978 | Walgreen Co. | Pharmacy | 152 N Buckman St, Shepherdsville, KY 40165-5900 | 2006-05-24 |
| 1467074229 | Pharmdtoyou, LLC | Pharmacy | 233 State Route 56 E, Sebree, KY 42455-9108 | 2020-05-14 |
| Find all providers with the same taxonomy | ||||
| City | LOUISVILLE |
| Zip Code | 40211 |
Please comment or provide details below to improve the information on PARK DUVALLE COMMUNITY HEALTH CENTER, INC.
| 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.