NPIMap

Organization Active NPI

PMR Ky Holding, LLC

Doing business as Jencare Neighborhood Medical Center Shivley, LLC

  • Community/Retail Pharmacy
  • Louisville, KY
National Provider Identifier
1083197388
Registry record updated Jul 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
PMR KY HOLDING, LLC
Doing business as
Jencare Neighborhood Medical Center Shivley, LLC
Practice address
3939 7TH Street Rd
Louisville, KY 40216-4103
Phone
(502) 775-1211
Fax
(502) 775-1221
NPI assigned
Sep 12, 2018
Last updated
Jul 24, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
PMR KY HOLDING, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 24, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mary Chen
Title
Executive Officer
Phone
(305) 628-6117

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X
Non-Pharmacy Dispensing Site 332900000X
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

3939 7TH Street Rd
Louisville, KY 40216-4103

Mailing address

1395 NW 167TH St
Miami Gardens, FL 33169-5710
Phone (305) 628-6117

Other names 1

  • Jencare Neighborhood Medical Center Shivley, LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
PMR US Holdings LLC2 organizations share this tax ID, including this one
Part of
PMR Ky Holding LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3939 7th Street Rd
Louisville, KY 40216
Phone (502) 775-1211

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1536710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690156800000",
    "number": "1083197388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 NW 167TH ST",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "331695710",
            "telephone_number": "305-628-6117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3939 7TH STREET RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402164103",
            "telephone_number": "502-775-1211",
            "fax_number": "502-775-1221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PMR KY HOLDING, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PMR KY HOLDING, LLC",
        "enumeration_date": "2018-09-12",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-24",
        "status": "A",
        "authorized_official_last_name": "CHEN",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "305-628-6117"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jencare Neighborhood Medical Center Shivley, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jencare Neighborhood Medical Center Shivley, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.