NEW SOURCE MEDICAL, LLC (NPI# 1700425816) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700425816 |
| Entity Type | Organization |
| Organization Name | NEW SOURCE MEDICAL, LLC |
| Practice Address |
9913 Shelbyville Rd Ste 203 Louisville KY 40223-2907 |
| Practice Telephone | 5022610050 |
| Mailing Telephone | 5022610050 |
| Enumeration Date | 2020-01-06 |
| Last Update Date | 2020-10-06 |
| Authorized Official Name | KEVIN A MCKIM (CEO) |
| Authorized Official Telephone | 5022610050 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 213E00000X | Podiatrist | Podiatric Medicine & Surgery Service Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | New Source Medical, LLC | 9913 Shelbyville Road, Suite 203, Louisville, KY 40223 |
| Iowa Business Entities | NEW SOURCE MEDICAL, LLC | 9913 Shelbyville Road, Suite 203, Louisville, KY 40223 |
| Street Address |
9913 SHELBYVILLE RD STE 203 |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40223-2907 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235605668 | Ashlee Brooke Colville | Counselor | 13121 Esat Point Park Blvd, Suite F, Louisville, KY 40223 | 2018-10-24 |
| 1831619758 | Tracie S Lain | Developmental Therapist | 13101 Eastpoint Park Blvd., Louisville, KY 40223 | 2017-06-21 |
| 1972051399 | Ruby Denise Brooks | Counselor | 1407 Lafontenay Ct, Louisville, KY 40223 | 2016-09-14 |
| 1427409085 | Victoria Krepps Terrell | Nurse Practitioner | 13301 Shelbyville Rd Ste 103, Louisville, KY 40223 | 2016-06-24 |
| 1033570098 | Mackenzie Sipes | Chiropractor | 401 Creason Ct Unit 205, Louisville, KY 40223 | 2016-03-17 |
| 1699151258 | Chelsey Layne Gorham | Marriage & Family Therapist | 13121 Eastpoint Park Blvd Ste F, Louisville, KY 40223 | 2015-08-06 |
| 1356764187 | Paula Renee Garner | Social Worker | 1015 Dorsey Lane, Louisville, KY 40223 | 2014-01-30 |
| 1588086508 | Lori Bettenhausen Williams | Ophthalmology | 1413 Evergreen Rd, Anchorage, KY 40223 | 2014-01-09 |
| 1417392259 | Lauren Parsons Berry | Dentist | 9780 Ormsby Station Rd, Suite 1200, Louisviile, KY 40223 | 2013-05-07 |
| 1336486653 | Lynn M Pendley | Dietitian, Registered | 9400 Mill Brook Rd, Northeast Ymca, Louisville, KY 40223 | 2013-01-07 |
| Find all providers in zip 40223 | ||||
| Taxonomy Code | 213E00000X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578112983 | Peter Cunningham | Podiatrist | 1 Audubon Plaza Dr Ofc L2, Louisville, KY 40217-1318 | 2019-09-09 |
| 1447787676 | Jenna Vaught LLC | Podiatrist | 3407 Kerry Dr, Louisville, KY 40218-2131 | 2017-05-18 |
| 1083907471 | Larry K Ketcherside | Podiatrist | 9110 Leesgate Rd, Louisville, KY 40222-5053 | 2011-05-18 |
| 1558516054 | Jessica S Jackson Dpm Pllc | Podiatrist | 15014 Bircham Rd, Louisville, KY 40245-4104 | 2008-11-25 |
| 1568625903 | Janine A. Valentino | Podiatrist | 9880 Angies Way Suite 110, Louisville, KY 40241-2943 | 2008-07-07 |
| 1205055332 | Achillies Foot and Ankle Center Inc | Podiatrist | 317 B Gutherie Green, Louisville, KY 40202 | 2007-04-25 |
| 1932277274 | John M Miller | Podiatrist | 335 W South Boulder Road, Suite 5, Louisville, CO 80027-1192 | 2006-12-04 |
| 1366542748 | Steven Richard Shlonsky | Podiatrist | 149 Thierman Lane, Louisville, KY 40207 | 2006-09-25 |
| 1841397320 | Family Foot and Ankle Care Pllc | Podiatrist | 130 N Evergreen Rd, Suite 102, Louisville, KY 40243-1489 | 2006-09-19 |
| 1497772255 | Jeffrey Kenneth Marzian | Podiatrist | 3403 Gatecreek Rd, Louisville, KY 40272-2687 | 2006-07-17 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 40223 |
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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.