NPIMap

Organization Active NPI

East Louisville Dermatology, PSC

  • Dermatology Physician
  • Louisville, KY
National Provider Identifier
1255468872
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
24086 Issued in KY
Legal business name
EAST LOUISVILLE DERMATOLOGY, PSC
Practice address
4912 US Highway 42
Suite 208
Louisville, KY 40222-6349
Phone
(502) 426-9565
Fax
(502) 425-3240
NPI assigned
Feb 28, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Terrie S Williams, M.D.NPI 1215064134
Title
President
Phone
(502) 426-9565

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 24086 KY Primary

Addresses

Primary practice location

4912 US Highway 42
Suite 208
Louisville, KY 40222-6349

Mailing address

4912 US Highway 42
Suite 208
Louisville, KY 40222-6349
Phone (502) 426-9565

National Provider Directory

National Provider Directory

Locations

4912 US Highway 42
Lowr 208
Louisville, KY 40222
Phone (502) 426-9565

4912 US Highway 42
Ste 208LL
Louisville, KY 40222

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1255468872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4912 US HIGHWAY 42",
            "address_2": "SUITE 208",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402226349",
            "telephone_number": "502-426-9565",
            "fax_number": "502-425-3240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4912 US HIGHWAY 42",
            "address_2": "SUITE 208",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402226349",
            "telephone_number": "502-426-9565",
            "fax_number": "502-425-3240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST LOUISVILLE DERMATOLOGY, PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "TERRIE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "502-426-9565",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "KY",
            "license": "24086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Aug 22, 2020; 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.